NURSING 7030 Nursing Research

Introduction:

Topic: The effectiveness of music therapy as a pain management intervention for paediatric patients.

Background: 

Although analgesia is one of the most common techniques for pain management for the patients, there are various side effects associated with prolonged usage of analgesics. As mentioned by Riddell et al. (2015), the most abundantly used pain medication type is opioid based drugs, which are associated with a variety of different complications and side effects. When considering the children, the use of opioid based pain management drugs is restricted by the most of the health authorities both locally and globally. Elaborating more, there are various side effects of all kinds of analgesics including opioids which are basically narcotic drugs with high risk of addiction, acetaminophen, steroids, NSAIDs; some of these side effects include constipation, drowsiness, dizziness, upset stomach, rashes or hypersensitivity reaction, and dry mouth. For the paediatric patients the risk and impact of these side effects are even higher (Pillai Riddell et al., 2015). Hence, the clinical governance and authorities have stated that the non-pharmacological pain medication techniques are the most effective and safe pain management technique, at least for the children. Music therapy is engaging soothing and attention grabbing at the some which can be very beneficial for calming children suffering from pain (Chaillet et al., 2014). This research proposal attempts to discover the effectiveness of the music therapy as a pain management technique for children.

Study aim and relevance: 

Children, when suffering from acute pain, due to either a disease process or in post-operative situation, managing pain successfully is one of the greatest challenges facing the nursing workforce (Mann & Carr, 2018). Among the various pharmacological pain management technique, the chances of dependence and adverse reactions complicate the safe managing of pain in the children.  Music therapy has emerged as a potent non-pharmacological as well as holistic intervention in the last decade. Although the exact impact of the music therapy to reduce the pain and calm an agitated and confused child distracting him or her from the time of suffering has not been researched extensively in the past (Krishnaswamy & Nair, 2016). This study will attempt to explore the impact of music therapy on both reducing the pain felt and calming the children in pain in a hospital setting.

Objectives:

The objectives decided for this particular research study include:

• To explore the usability and efficiency of music therapy as a pain management technique
• To assess the calming effects of the music therapy on the children as patient population
• To explore the applicability of the music therapy in health care setting successfully
• To understand the perception and knowledge among nursing staff and parents regarding the use of music therapy as pain management

Research question: 

The research question for this study are:

• What is the usability and efficiency of music therapy as a pain management technique?
• What is the extent of the calming effects of the music therapy on the children as patient population?
• How applicable is music therapy in health care setting involving children?
• What are the perception and knowledge base among nursing staff and parents regarding the use of music therapy as pain management?

Conceptual framework: 

Literature review:

Introduction: 

This research proposal will focus entirely upon the usage of music therapy as an emerging non-pharmacological means of pain management in the patient population of children. Music or anything as aesthetic has been proven to be an easy and feasible distraction technique for the paediatric patients that are supposed to undergo a harsh medical procedure. However, large scale implementation of the music therapy in reducing pain is still a grey area in the nursing practice. However, there is mounting evidence that has reported considerable effectiveness of this music therapy in the clinical setting to distract the patients and soothe their pain and discomfort (Bradt et al., 2016).

The pain associated with a disease or a surgical procedure is often considered as one of the worst experiences that the patients go through during their stay in the health care facility. It has to be mentioned in this context that pain is not just limited to a distressing physical experience, the impact of pain is also extended to the psychological and emotional wellbeing status of the patient as well (Gohel, Parmar & Joshi, 2016). Although the non-pharmacological pain management techniques are useful in managing the physiological impact of the pain, it has no impact on the psychological or emotional impact of the pain. The non-pharmacological pain management techniques on the other hand is more holistic, addressing the multifaceted impact of pain and helps the patient overcome the overall aftermath of pain (Sin & Chow, 2015).

Music therapy in acute and palliative care setting: 

The patients in palliative care often face the most crucial pain; the article by Gutgsell et al. (2013), has stated that the treatment of pain in the palliative unit is often the most challenging task and music therapy serves as a safe and reliable adjunctive non-pharmacological method for pain management. This randomized control trial has been successful in describing significantly decreased rate of pain scoring in the patients that has been given the aid of music therapy. The authors have been successful in the describing music therapy to be an intervention that incorporated therapist guided autogenic relaxation technique that remarkably lowered pain in the palliative patients.  

Burn patients when having to go through change of dr5essing are often required to go through acute pain, discomfort and distress. Authors Tan et al. (2010), have described the effect of two different music therapy protocols on the pain management and distracting the patients that are going through the pain that they are experiencing. The intervention used by the authors in this study had been music based imagery which is a form of music-assisted relaxation with patient-specific mental imagery before and after their dressing had been changed. The results of the studies indicate that the pain levels experienced in the control days had been significantly higher than that experienced when the patient received the intervention of the music based imagery. Hence, the impact of music based interventions based on the music alternate engagement is far more effective in distracting the patients from acute distressing pain and can be applied to the paediatric setting as well.

Music therapy on post-operative pain: 

On a similar note, the review by Bernatzky et al. (2011), states that the music therapy and its use as the adjuvant to the pain control mechanism in the clinical setting, especially in the post-surgical scenario. It has to be mentioned that the stress and anxiety is a common aftermath linked with surgery and it has been found to exacerbate the experience of pain in the patient. Using music as a part of the multimodal pain management technique has been exceptionally successful in reducing the sensation of pain and also calming the symptoms of stress and anxiety. The systematic review study by the Eccleston et al. (2016), states that for the children that are suffering from acute or chronic pain, the distressing impact of the pain enhances the experience of pain causing irritability, agitation and an overpowering sense of distress in the paediatric patients, further complicating the treatment process for the patients. Hence, to be able to provide a holistic pain management technique for the paediatric patients, the multimodal non-pharmacological pain management is necessary for these children to be able to feel better and music therapy does not only help in reducing the feeling of pain, it distracts the patient completely for the distresses felt.

Exploring the available literature on the effectiveness of the music therapy on post-operative pain setting, authors Liu and Petrini (2015), have stated music therapy can be a soothing adjuvant intervention that has positive impact on post-operative pain, anxiety and the vital signs as well. This randomized control trial has successfully documented music therapy to be helping not just in reducing the pain but also lowering the systolic blood pressure of the patents in the post-operative phase by reducing anxiety and stress. However, the small sample size reduces the generalizability of the research study which can be considered a significant limitation of the study. Similarly neuropathic pain is extremely acute and has a delimiting along with exhausting impact on the psyche of the patient. the quasi-experimental study by the Korhan et al. (2014), has stated that a 60 minutes of music therapy intervention can help the patients with neuropathic pain in the algology clinic experienced lesser intensity of the pain. However, this research study lacks any input on the exact mechanism how the duration of the music interventions relates to the reduced pain intensity.

Music therapy on paediatric patients: 

From the above mentioned review of the literature, it is clear that the music therapy has a positive impact on not just reducing the impact of the pain that the patients feel, but it also acts as the holistic means of pain management which helped reduce the impact of acute pain on the vital signs and stress levels. Now exploring the literature on how the music therapy on the children experiencing pain in the hospital setting, the article by Suresh, De Oliveira and Suresh (2015), can be mentioned easily. This randomized control trial study has directly focused on the effect of audio therapy to manage and minimize the post-operative pain in the children that have gone through a severe injury. The linear regression method of arriving at the verdict indicated that the use of audio therapy helped the nurses manage the pain sensation of these children going through acute post-operative pain and also helped to calm them.

Although the sample size of this study is very small which limits the generalizability of the study effectively and along with that the study utilized both music and audiobook in the intervention which can be considered a restriction in understanding the individual impact of the music therapy as an alternative to analgesics. Another medical procedure that causes immense pain in the children can be considered the lumbar puncture which has been reported to cause immense pain and discomfort in children, especially the cancer patients. The article by Nguyen et al. (2010), has emphasized on the applicability of the music therapy in reducing both pain and anxiety of the cancer patients going through the lumbar puncture. The results showed that both pain scores and anxiety scores in the children that received the music therapy than those that did not receive it. Although, the sample size had also been considerably lower in this case as well, but this study helps in further validating the results generated of music therapy on the children as well. Another study by Aydin and Sahiner (2017), has evaluated the impact of both music therapy and distraction cards on the pain relief technique of the chi8ldren that are going to9 go through phlebotomy, where the researchers discovered the highest level of pain reduction when both music and distraction cards were used for the patients.

Conclusion: 

All of the articles that have been evidenced here has stated that music therapy is in fact a very efficient and multifaceted pain relief technique and can even act on calming the vital signs of the patients along with reducing the sensation of pain. The strengths of the article shave been the consistent data results, adequate description and clear research aim. However, small sample size, lack of generalizability and bias management limited the efficacy on the other hand. Another key research gap had been the lack of emphasis on the nursing knowledge of music therapy and applicability of this therapy in the clinical setting, which needs to be identified in further research as well.

Research methodology:

The research methodology can be defined as the step by step systematic account of each and every activity that the researcher is going to undertake in order to complete the research procedure and be able to achieve the objectives and goals set (Creswell & Poth, 2016). For this research study, the design selected is primary qualitative research based on interviews. The rationale behind the choice of the qualitative research design can be the fact that to understand the exact impact of the music therapy as a pain management technique the accurate feelings and thoughts of the patient needs to be taken into account. Along with that, the exact level of knowledge among the nurses regarding how to apply music therapy in practice and the perception of the parents cannot be evaluated by just quantitative data, hence qualitative research design has been chosen to achieve the exact outcomes of the research study.

The participants will be two different groups who will be selected based on the purposeful sampling, where the nurses and the patients of the paediatric ward of the hospital will be selected. There are various benefits of using purposeful sampling, it provides the aid of targeted sampling, accurate results and allows the research study to be concluded in multiple phases (Palinkas et al., 2015). As this research design involved two different phases, the purposeful sampling will be extremely beneficial. The study will be completed in two halves. In the first half, the paediatric ward nurses of the facility will be randomly selected to go through a music therapy application and use interview to explore their knowledge and understanding of the concept followed by a brief training on music therapy use. In the second half, paediatric patients and their family members would be selected to be interviewed before and after the music therapy intervention implementation for two weeks indicating how effective it has been to reduce pain (DiCenso, Guyatt & Ciliska, 2014). The interviews will be semi-structured and the interviews will be conducted in a face to face interaction mode based data by the same person to minimize the possibility of bias. This particular interview technique provides the participants with the opportunity to express their exact feelings and ideas and enriches the quality of the data that is being collected. The instruments of data collection will be digital audio recorders, transcript coding software, audio tapes and statistical analysis software. Hence, this method of data collection has been selected by the researchers in the study. The interview will be recorded using the audio tapes and the data will be coded along with jotted down by the volunteers participating in the research study. The data analysis will be coding based and the results will be adequately and consistently provided with the help of tabular representation (Elo et al., 2014). The emergent themes from the interview data then will be explored and discussed accordingly.

Ethical consideration:

The ethical consideration is a very important aspect associated with a research study which strengthens the integrity of the research study and helps the researcher adhere by the ethical guidelines and principles of concluding a human subject based research study (Houghton et al., 2013). The researchers will be undertaking a thorough and extensive process of informed consent for this research where each and every participants of the both participant groups will be both verbally and in written be provided the exact extent of the research study and will be given complete freedom to discontinue the research at any point. The privacy and confidentiality of the personal information shared by the participants will also be protected by the interviewers and the researchers taking extra attention to ensure none of the private data is leaked. The participants will also be given complete freedom to not disclose any personal data that they do not want to share. The data collected and analysed will be protected by all means and will be stored in a secure manner so that there is no risk of breach. Although, there are no considerable risks associated with this research, care would be taken to ensure to inform the participants of the any plausible risk if encountered while carrying out the study (Lewis, 2015). The researchers will be also be taking additional care to ensure that all the ethical principles of conducting research involving human subjects.

Conclusion:

On a concluding note, the medical researchers have been indicating the adverse effects that the analgesic drugs that are being used in the pain management techniques. Hence, the emphasis had been on the usage of non-pharmacological pain management techniques that can be applied as the alternative to the analgesics that are generally used in the clinical setting. Music therapy had been proved as a potent tool for pain management techniques for patients. The literature that has been reviewed for this proposal had been successful in exploring multifaceted benefits of using music therapy interventions for pain relief. It has to be mentioned that the pain in acute or chronically ill patients also manifest as anxiety, agitation, irritability and hopelessness which in most cases even affects the vitals of the patient and complicates the treatment and recovery process. The evidence reviewed suggests that the use of music therapy distracts and calms the patiensta nd minimizes the impact of the pain and helps them focus on something else other than the sensation of pain which can be very beneficial in captivating the children in pain. The existing literature on the impact of music therapy is little and it does not elaborate the applicability of the therapeutic interventions, and the perception of knowledge of the nursing workforce of this intervention which can shed light on the exact need of training of the nurses in these non-pharmacological alternative methods for pain. Hence, this proposal also aims to explore the applicability of this intervention in clinical pediatric setting and the knowledge of the nurses along with the efficiency of the intervention. It can be hoped that this research will be able to highlight key applicative benefits of the music therapy and will inform nursing practice commendably.

References:

Aydin, D., & Sahiner, N. C. (2017). Effects of music therapy and distraction cards on pain relief during phlebotomy in children. Applied Nursing Research, 33, 164-168.

Bernatzky, G., Presch, M., Anderson, M., & Panksepp, J. (2011). Emotional foundations of music as a non-pharmacological pain management tool in modern medicine. Neuroscience & Biobehavioral Reviews, 35(9), 1989-1999.

Bradt, J., Norris, M., Shim, M., Gracely, E. J., & Gerrity, P. (2016). Vocal music therapy for chronic pain management in inner-city African Americans: A mixed methods feasibility study. Journal of music therapy, 53(2), 178-206.

Chaillet, N., Belaid, L., Crochetière, C., Roy, L., Gagné, G. P., Moutquin, J. M., … & Bonapace, J. (2014). Nonpharmacologic approaches for pain management during labor compared with usual care: a meta?analysis. Birth, 41(2), 122-137.

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Cridland, E. K., Jones, S. C., Caputi, P., & Magee, C. A. (2015). Qualitative research with families living with autism spectrum disorder: Recommendations for conducting semistructured interviews. Journal of Intellectual and Developmental Disability, 40(1), 78-91.

DiCenso, A., Guyatt, G., & Ciliska, D. 2014. Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Eccleston, C., Palermo, T. M., de C Williams, A. C., Lewandowski, A., Morley, S., Fisher, E., & Law, E. (2016). Psychological therapies for the management of chronic and recurrent pain in children and adolescents. The Cochrane Library, CD003968.

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Gohel, V. D., Parmar, N., & Joshi, V. (2016). Use of soothing music on pain alleviation during intramuscular injection in children. Int. J Basic Appl. Physiol, 5(1), 44.

Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris, M., … & Wiencek, C. (2013). Music therapy reduces pain in palliative care patients: a randomized controlled trial. Journal of Pain and Symptom Management, 45(5), 822-831.

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Korhan, E. A., Uyar, M., Eyigör, C., Yönt, G. H., Çelik, S., & Khorsh?d, L. (2014). The effects of music therapy on pain in patients with neuropathic pain. Pain Management Nursing, 15(1), 306-314.

Krishnaswamy, P., & Nair, S. (2016). Effect of music therapy on pain and anxiety levels of cancer patients: a pilot study. Indian journal of palliative care, 22(3), 307.

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Liu, Y., & Petrini, M. A. (2015). Effects of music therapy on pain, anxiety, and vital signs in patients after thoracic surgery. Complementary Therapies in Medicine, 23(5), 714-718.

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Nguyen, T. N., Nilsson, S., Hellström, A. L., & Bengtson, A. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial. Journal of Pediatric Oncology Nursing, 27(3), 146-155.

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533-544.

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Tan, X., Yowler, C. J., Super, D. M., & Fratianne, R. B. (2010). The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial. Journal of Burn Care & Research, 31(4), 590-597.

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