Patient-Directed Music Therapy as an Adjunct During Burn Wound Care

Abstract

Our burn unit provides comprehensive burn care to patients ranging in age from newborn to 90 years. Pain control during daily wound care is accomplished with procedural sedation, but escalating anxiety of patients before and during hydrotherapy and wound care remains a common obstacle. Our use of complementary and alternative medicine to augment pain control includes relaxation, meditation, and distraction through the use of staff-directed conversation and ambient music. Until recently, technical difficulties with equipment and radio reception and the wide range of genres necessary to satisfy this multiage patient population have made passive music therapy the least effective of these interventions. The addition of Internet radio, broadcast via wireless (Wi-Fi) and accessed through the hospital’s intranet, has proven an inexpensive and resourceful solution to this problem.The National Center for Complementary and Alternative Medicine groups music therapy in the mind-body medicine category along with meditation, prayer, hypnosis, yoga, and relaxation. These therapies attempt to reduce symptoms by enhancing bodily functions.1 Music therapy can be as simple as passive listening to ambient music or it can involve active engagement in music making with the assistance of a trained music therapist. Our interest in the use of music as an adjunct to procedural sedation for treatment of pain and anxiety involves having patients select music and passively listen to that music during burn wound care procedures.Use of music therapy during out-patient procedures in adults and children is associated with decreases in procedure length and total narcotic use along with increases in satisfaction among patients.2–4 Theories on how patient-selected music soothes and comforts suggest that music helps to familiarize the procedure environment, provides distraction from the procedure, and allows the patient some autonomy.5,6 We have found that sounds that are familiar to the patient help to lessen the fear of the unknown while providing a focus for distraction. Similar to having patients pick a cast color before splinting a fracture or choose the flavor of anesthetic before surgery, having patients choose the music offers patients an important measure of control over an unpleasant yet necessary procedure.Ambient music may also improve interactions among members of the health care team. Staff reports of the positive effect of music in the operating room include creation of a more efficient and calm environment.7 Reports of nurses who witnessed oncology patients receiving music therapy highlight improved work environments and the ability to provide better care for patients.8 We find that ambient music provides a rhythm to staff movements and communication that may subconsciously synchronize members of the health care team to each other and the patient.Patient-preferred music is an important component of the successful use of music therapy during procedures.9 Vanderboom10 offers a few guidelines in the use of music therapy during procedures:Additionally, we involve the primary caregiver in identifying any familiar songs that may comfort our pediatric patients. We also ensure that volume is adjusted for the hearing impaired or elderly patients and that procedural sounds do not override the music.After receiving institutional approval for bandwidth requirements, we installed 2 separate speaker/amplifier systems in our adjacent treatment rooms. The first room uses our existing computer/soundcard as a Wi-Fi receiver to access an Internet radio broadcast. The computer remains accessible for documentation of all patient care while music is playing. The second treatment room uses an Internet radio as the receiver to access the Internet radio broadcasts via a local area network (LAN) cable. Both systems enable users to select music by genre or particular station or specific artist by using the computer. Similar systems are available that access via Wi-Fi and include options to encode for password-protected hospital security systems.Multiple Internet radio Web sites offer free access (see TableT1), some have time limits or brief commercials, and other sites are easier to search or use to select a specific genre or artist. Most allow user-assembled “stations” to be saved for future logins with account registration. The total cost of the addition of music using an Internet radio source, with the installation and hardware for 2 separate room systems, was less than $1300.The addition of music to our hydrotherapy room continues to receive overwhelmingly positive feedback. Patients refer to their hydrotherapy as “The Spa” (see FigureF1), and staff appreciate the relaxed atmosphere. Although rigorous studies on the effect of patient-directed passive music therapy on control of pain from burn wounds are not available, we have found the addition of music to be inexpensive, easy to implement, and lacking any adverse effects.“In Our Unit” highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming “In Our Unit,” send it to Critical Care Nurse, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, ccn@aacn.org.