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Pro questdocuments 2013-11-13(1) Document Transcript

  • 1. _______________________________________________________________ _______________________________________________________________ Report Information from ProQuest 13 November 2013 09:08 _______________________________________________________________ 13 November 2013 ProQuest
  • 2. Table of contents 1. Using massage and music therapy to improve postoperative outcomes..................................................... 13 November 2013 ii 1 ProQuest
  • 3. Document 1 of 1 Using massage and music therapy to improve postoperative outcomes Author: McRee, Laura D; Noble, Stacie; Pasvogel, Alice Publication info: Association of Operating Room Nurses. AORN Journal 78.3 (Sep 2003): 433-42, 445-7. ProQuest document link Abstract: McRee et al determine whether massage and music therapy could decrease anxiety, resulting in positive outcomes related to cardiovascular hemostasis and decreased pain for patients. After conducting a variety of studies related to the effects of massage or music therapy on patients' anxiety, results indicate that postoperative anxiety levels were significantly lower and postoperative prolactin levels were significantly higher for all groups. Full text: Headnote ABATRACT * AN EXPERIMENTAL PILOT STUDY was conducted to investigate the effects of preoperative massage and music therapy on patients' preoperative, intraoperative, and postoperative experiences. * PARTICIPANTS were assigned randomly to one of four groups-a group that received massage with music therapy, a group that received massage only, a group that received music therapy only, or a control group. * HEMODYNAMICS, serum cortisol and prolactin levels, and anxiety were measured preoperatively and postoperatively. * POSTOPERATIVE ANXIETY LEVELS were significantly lower and postoperative prolactin levels were significantly higher for all groups. AORN J 78 (Sept 2003) 433-447. Whether surgery is emergent or elective, the experience causes patient anxiety, which can be detrimental to surgical outcomes.1 The anticipation of pain may cause increased anxiety, and, in turn, anxiety and pain cause an increase in levels of circulating catecholamines, adrenocorticotrophic hormone, growth hormone, prolactin, antidiuretic hormone, aldosterone, cortisol, glucagon, prostaglandins, and free fatty acids.2 An increase in stress hormones and resulting metabolic responses can lead to a variety of morbid events, including myocardial and other organ ischemia, dysrhythmia, hypercoagulability, malnutrition, fluid and electrolyte imbalance, decreased wound healing, and immunocompromise.2 Anxiety increases oxygen consumption, cardiac output, and blood pressure.3 Furthermore, anxiety and stress can increase the need for higher doses of anesthetics and sedatives during surgical procedures, resulting in a potentially negative effect on a patient's recovery.3 Fear of pain is a significant fear ranked second only to fear of death;4 therefore, it is important for surgical teams to be aware of interventions that could decrease anxiety and pain. LITERATURE REVIEW This study was designed to determine whether massage and music therapy could decrease anxiety, resulting in positive outcomes related to cardiovascular hemostasis and decreased pain for patients. A variety of studies related to the effects of massage or music therapy on patients' anxiety have been conducted. MASSAGE THERAPY. Massage is the art of touch and manipulation of soft tissue to achieve therapeutic results, including mental relaxation, comfort, and healing.5 Massage has been considered a therapeutic intervention for thousands of years. There is evidence of the use and value of therapeutic massage in China more than 5,000 years ago.6 A person's tactile needs do not change with health or aging; however, patients who are acutely ill or undergoing surgery seldom are touched other than when they are receiving necessary care.5 Caring touch, compared to technical or mechanical touch, is an important method of communication.7 There are a number of theories about the mechanisms for massage's therapeutic effects on psychological and physical status. Most simply, massage may relieve pain through muscle relaxation and the release of enkephalins.6,8 13 November 2013 Page 1 of 14 ProQuest
  • 4. The gate control theory of pain also has been used to explain the effectiveness of massage in pain control.6 According to this theory, tactile information from massage is carried on the large myelinated fibers, which may close the neurological "pain gate" at the peripheral point, thus reducing the perception of pain. Two other mechanisms for pain relief through massage have been identified: * soft tissue manipulation improves circulation, which reduces pain caused by the accumulation of irritants, including lactic acid and inflammatory substances; and * the emotional contact of caring touch may induce a sense of well-being that would diminish the perception of pain.9 Results of previous studies have demonstrated therapeutic benefits of massage in a variety of circumstances, especially in terms of decreased anxiety, decreased stress response, and less pain. In a study of the effects of massage on 122 patients admitted to an intensive care unit (ICU), participants were assigned randomly to receive massage, aromatherapy and massage, or a period of rest.10 Preintervention and postintervention assessments included physiological stress indicators and patients' evaluations of their anxiety level, mood, and ability to cope with the intensive care experience. No significant differences were reported in the physiological stress indicators, which included systolic and diastolic blood pressure, heart rate and rhythm, and respiratory rate. The group that received massage and aromatherapy, however, demonstrated significant improvements in mood and reported decreased anxiety after therapy. One study evaluated the effects of massage on anxiety among older adult, institutionalized patients.11 Participants were assigned randomly to a group that received a five-minute back massage and engaged in conversation with the massage therapist, a group that participated in a five-minute conversation only, or a group that received no interventions. Anxiety was measured using the Spielberger State-Trait Anxiety Inventory (STAI) before and after interventions and at two points in time for the group that received no interventions. The study was conducted during four consecutive days. Mean anxiety scores indicated that anxiety levels were significantly lower for the group that received massage compared to the group that received no interventions. One group of researchers studied the effects of massage on 28 patients in a hospital burn unit.12 Patients were assigned randomly to a massage therapy group or a standard treatment control group before undergoing a debridement procedure. The group that received massage demonstrated less anxiety, lower cortisol levels, less pain, and less depression than the group that received standard care. A limitation of this study is the lack of a comparison intervention; therefore, it cannot be determined whether an intervention other than massage would have produced the same effects. One researcher studied the effects of therapeutic massage on preoperative anxiety, gathering both quantitative and qualitative data.13,14 Sixty patients undergoing general surgical or gynecological procedures were selected from a rural hospital. The treatment group included 30 patients who received 45 minutes of preoperative massage. The control group did not receive any interventions. Measures included anxiety as indicated by scores on the STAI, the amount of analgesia required, and length of hospital stay. In addition, study participants were interviewed during their massages to elicit their perceptions of the experience. The results demonstrated that the group that received massage experienced reduced preoperative anxiety compared to the control group; however, there were no significant differences in amounts of analgesia used or length of stay between the two groups. Analysis of participant interviews revealed that those who received massage believed their vulnerability was respected and that the massage provided an environment in which they felt safe to talk. A limitation of this study is, again, lack of a comparison intervention. 13 November 2013 Page 2 of 14 ProQuest
  • 5. MUSIC THERAPY. Music has been defined as the science or art of the composition of sounds that are comprehended by the human brain as enjoyable and expressive.3 In the 1800s, music was used to aid sleep, decrease anxiety associated with surgery, and assist in the administration of local anesthesia.2 The physiological effects of music have been measured using blood pressure, mean arterial pressure, heart rate, electrocardiogram, respiratory rate, oxygen saturation, finger temperatures, and serum hormone levels.15 Many studies have examined the effect of music on patients' anxiety. One study examined the effects of music use in various medical specialties, including anesthesiology, surgery, orthopedics, dentistry, and obstetrics. Patients selected the music they preferred and listened to it during the preoperative wait. Headphones were left on until patients were asleep. Patients who received local anesthesia wore headphones during the entire procedure. Findings included decreased levels of anxiety, decreased blood pressure, and decreased hormone levels, including prolactin, cortisol, adrenocorticotrophic hormone, growth hormone, and norepinephrine.16 A pilot study of 30 patients scheduled for elective orthopedic surgical procedures performed using regional anesthesia was conducted to determine whether having patients listen to their favorite music while undergoing the surgical procedure reduced their anxiety.3 Data were collected using questionnaires designed to obtain feedback about patients' selections and their feelings about listening to music during surgical procedures. Patients reported that music helped the surgery go more quickly, masked background noises, and diverted their minds from the procedure. Perioperative staff members provided positive feedback about the use of music, and anesthesia care providers noted that participants were calmer throughout the procedures, pulse and blood pressures remained more stable, and less anesthesia was required. 13 November 2013 Page 3 of 14 ProQuest
  • 6. The psychological and physiological effects of music have been studied in a variety of clinical settings including ICUs, surgical suites, and postanesthesia care units (PACUs). One group of researchers investigated the physiological effects of music therapy on 22 critically ill patients in an ICU.17 Reduction in heart rate, systolic blood pressure, pain, and anxiety were reported. Another researcher conducted a six-month study in which music was played for five minutes before the start of painful procedures. Patients who listened to music used 30% less pain medication than those who did not listen to music.18 Studies have examined patients' perceptions of their surgical experiences, including preoperative, intraoperative, and postoperative care. One researcher investigated the effects of humorous and musical distraction on preoperative anxiety in 46 13 November 2013 Page 4 of 14 ProQuest
  • 7. patients scheduled for same day elective surgery.19 The study included three groups: one group that listened to music for 20 minutes, a second group that listened to a 20-minute humorous audiotape, and a control group that received standard care. No significant differences in anxiety scores were reported. Another researcher conducted a pilot study that investigated patients' perception of music during their surgical experience.20 The study included 25 participants who underwent elective surgery receiving either a local, spinal, or epidural anesthetic. Patients were interviewed 20 hours after surgery. Their remarks indicated that music eased anxiety, provided distraction, and increased their pain thresholds. The effect of music on pain and hemodynamic measurements (ie, mean arterial pressure, heart rate, respirations) in the PACU for patients who had undergone thyroidectomy, parathyroidectomy, or modified mastectomy was the subject of one study.21 One group of participants wore headphones and listened to music, another group wore headphones but did not listen to music, and a control group did not wear headphones or listen to music. Members of the group that listened to music were able to wait significantly longer before requiring pain medication compared to members of the group who wore headphones but did not listen to music. Members of the group that listened to music perceived their PACU experience as significantly more pleasant than did the other two groups. No significant differences were reported in hemodynamics, respirations, pain, or length of stay in the PACU. One group of researchers examined the influence of three interventions on anxiety during the early postoperative phase of patients undergoing heart surgery.22 Participants were assigned randomly to one of three groups. One group received music therapy, a second group received music-video therapy (ie, participants watched a 30-minute videotape in which soft instrumental music accompanied visual images on a television screen), and a third group received scheduled rest. Interventions were 30 minutes in length, and participants received interventions at two separate times-on postoperative day two and postoperative day three. Mood and anxiety were evaluated before and after each session. Anxiety was measured before surgery, before the intervention session on postoperative day two, and at the completion of the session on postoperative day three. Blood pressure and heart rate were measured immediately before the intervention and at 10-minute intervals during the intervention. Members of all three groups reported reduced anxiety and improved moods and experienced significant decreases in mean heart rate and blood pressure. The decreases occurred within the first 10 minutes of the intervention and continued for the remainder of the study period. Another researcher investigated sensory and affective pain in 84 participants who underwent nonlaparoscopic, elective abdominal surgery.23 Each participant was assigned randomly to one of four groups: a group that practiced jaw relaxation, a group that listened to music, a group that listened to music combined with practicing jaw relaxation, and a control group that received no intervention. The participants in the jaw relaxation group followed audiotaped instructions to perform the relaxation exercises. Participants in the music group selected and listened to one of five choices of relaxing music audiotapes. Participants in the jaw relaxation with music group practiced jaw relaxation techniques while listening to their choice of one of the five music audiotapes. No significant differences were reported in the areas of sensation, distress, anxiety, or narcotic intake between the three intervention groups and the control group. In a study of the effect of music on 42 ambulatory surgery patients' anxiety, participants in the experimental group listened to their choice of music after receiving preoperative instruction, and participants in the control group received only preoperative instruction.24 Ten minutes before surgery, vital sign measurements were taken and compared to baseline vital sign measurements. Participants in the experimental group demonstrated significantly lower heart rates than participants in the control group. PURPOSE The purpose of this pilot study was to investigate the effects of preoperative therapeutic massage and music therapy on patients' preoperative, intraoperative, and postoperative experiences. Identifying ways to decrease preoperative anxiety could result in the use of less anesthesia for induction, the use of less postoperative 13 November 2013 Page 5 of 14 ProQuest
  • 8. analgesia, and fewer complications from stress-related responses-outcomes that could lead to decreased costs for hospitals and patients. Furthermore, established empirical data may provide justification for offering massage and music therapy as a preoperative standard of care. RESEARCH QUESTIONS The following research questions were asked. * Are there differences between preoperative and postoperative anxiety, cortisol levels, and prolactin levels among the groups? * Are there differences in preoperative and postoperative anxiety, cortisol levels, and prolactin levels within each group? * Are there differences between preoperative, intraoperative, and postoperative blood pressures and pulse rates among the groups? * Are there differences in preoperative, intraoperative, and postoperative blood pressures and pulse rates within each group? * Is there a difference in the percentage of participants in each group who received postoperative pain medication? METHOD The study employed a four-group experimental design, including three intervention groups and one control group. Patients in one group received 30 minutes of massage and listened to 30 minutes of music before surgery. Patients in a second group received 30 minutes of massage before surgery, and patients in a third group listened to 30 minutes of music before surgery. Patients in the control group received standard care. SETTING AND PARTICIPANTS. Data were collected at the University Medical Center (UMC), Tucson. A private room was provided for the researcher to meet with study participants. Approval for the study was obtained from the human subjects committee of the University of Arizona and from the Institutional Review Board of UMC. Selection criteria included that participants be at least 18 years of age and able to read English. In addition, participants needed to be low-risk surgical patients as determined via preoperative assessment by the anesthesia care provider using the standards of American Society of Anesthesiologists scale. This scale is based on the number and severity of preexisting medical conditions. The range is from a normal healthy patient (ie, one) to a patient who is declared brain dead and whose organs are being removed for donation (ie, six).25 The surgical schedule provided information to identify potential participants who then were recruited for the study the morning of surgery. All patients who met the criteria were invited to participate in the study by the nurse researcher. Data were collected during a one-year period. DEFINITIONS AND INSTRUMENTS. This study was concerned with participants' state anxiety. State anxiety was defined as the intensity of apprehensive feelings experienced at a particular moment as measured by the STAI six-item short form (STAI-6). The STAI is one of the most frequently used measures of anxiety. The STAI6 was developed for use in circumstances in which the full form is inappropriate due to its length.26 The range of scores for the STAI-6 is zero to 36. The concurrent validity of the short form was determined by comparing prorated scores from the six-item scale with those from the full scale. No differences in scores were reported. The reliability for the six-item scale was 0.82.26 In the present study, the reliability of the instrument was tested using Cronbach's alpha to determine the internal consistency of the items. The alpha was 0.79 for this study. Systolic blood pressure is maximum blood pressure that occurs during contraction of the ventricle.27 (p2126) Diastolic blood pressure refers to the period of cardiac relaxation alternating with systole or contraction.27 (p587) Pulse is defined as the rate, rhythm, condition of arterial walls, compressibility and tension, and shape of the fluid wave of blood traveling through the arteries as a result of each heart beat.27 (p1794) Intraoperative measurement for blood pressure and pulse was obtained by the anesthesia care provider using automatic 13 November 2013 Page 6 of 14 ProQuest
  • 9. monitoring equipment. Postoperative blood pressure and pulse were obtained by the primary investigator or research assistant using automatic monitoring equipment. Cortisol is a glucocortical hormone of the adrenal cortex.27 (p492) The method used for cortisol determination was chemiluminescent immunoassay using a polyclonol rabbit antibody specific for cortisol. Prolactin is a hormone produced by the anterior pituitary gland.27 (p1761) The method used to determine prolactin levels was a two-site sandwich antibody assay (ie, a specific chemiluminescent assay). Blood was sent to a regional laboratory for processing. The same laboratory processed all samples. Instruments at the laboratory were calibrated monthly or based on reagent stability. Pain control, defined as the amount and frequency of analgesia administered, was measured in the recovery room. Patients were asked about their levels of pain, and all medications were administered by PACU nursing staff members. INTERVENTIONS. Patients were required to be at the hospital two hours before surgery. Interventions were provided during the first hour of this two-hour period. During this time, the control group waited in the waiting room and followed the usual routine for perioperative patients. Members of the massage with music and massage only groups received 30 minutes of massage. Swedish massage techniques were used in this study. The strokes used were effleurage (ie, long gliding strokes), petrissage (ie, lifting of the muscle, kneading), and vibration (ie, gentle shaking of the muscle). One nurse massage therapist provided all the treatments. All participants who received massage were lying face down on a massage table. Only the posterior body was massaged, including the neck, back, posterior arms, lower extremities, and feet. Participants in the music group and the massage with music group listened to the same compilation of soft piano music selected by the primary investigator. The compilation was 30 minutes in length. The music with massage group received both interventions simultaneously. PROCEDURES. Data were collected by the primary investigator and one research assistant who was trained in phlebotomy and oriented to the questionnaires provided to each participant. When patients agreed to participate in the study, each signed an informed consent form. 13 November 2013 Page 7 of 14 ProQuest
  • 10. A demographic questionnaire and the STAI-6 were completed by each participant, and serum cortisol and prolactin samples were obtained. Participants then were assigned to one of the four groups by drawing of lots. Blood pressure and pulse were measured preoperatively, and then interventions were administered. Blood pressure and pulse also were measured intraoperatively and postoperatively. Pain control was measured in the recovery room. Serum cortisol and prolactin levels were obtained again postoperatively, and each participant again completed the STAI in the PACU. DATA ANALYSIS Descriptive statistics were used to describe the sample. Paired t tests were used to determine the differences between preoperative and postoperative anxiety, blood pressure, pulse, and cortisol and prolactin levels within each group. Analysis of variance was used to determine differences among groups in preoperative and postoperative measures of anxiety and cortisol and prolactin levels, as well as preoperative, intraoperative, and postoperative blood pressure and pulse. Analysis of variance was used to determine differences among preoperative, intraoperative, and postoperative blood pressure and pulse within each group. Chi-square analysis was used to determine differences among the groups for those who received postoperative pain medication. The significance level was set a priori at P <or = .05. RESULTS Fifty-two patients participated in the study. Each group included 13 participants. The age range of participants was 19 to 67 years (mean = 43.08, standard deviation = 13.1). Nineteen participants were male, and 33 participants were female. All but one of the participants were high school graduates; 19 (36.5%) were college graduates. Eighty-four percent had undergone previous surgeries, and 44.2% had experienced massage therapy previously. There were no significant differences in demographic characteristics among the groups. Type of surgery varied, including cholecystectomy cystoscopy, Hickman catheter placement, hysterectomy, laparoscopy, lipoma removal, mass excision, and orthopedic hardware removal. Types of anesthesia used during the procedures included general, spinal, regional, and local anesthesia. Postoperative mean anxiety scores were significantly lower than preoperative scores for each of the groups (P <.05) (Table 1). There were no significant differences among the groups in mean preoperative anxiety scores (F^sub 3,48^ = 0.08, P = .97) or mean postoperative anxiety scores (F^sub 3,48^ = 1.48, P = .23). Preoperative and postoperative prolactin levels are presented in Table 2. There were no significant differences among groups in mean preoperative prolactin levels (F^sub 3,46^ = 0.58, P = .63) or mean postoperative prolactin levels (F^sub 3,48^ = 0.76, P = .52). The mean postoperative prolactin levels were significantly higher than the mean preoperative levels for each group (P <.05). Preoperative and postoperative cortisol levels are presented in Table 3. There were no significant differences among the groups in mean preoperative cortisol levels (F^sub 3,45^ = 0.8, P = .5) or mean postoperative cortisol levels (F^sub 3,48^ = 0.41, P = .75). There were no significant differences among mean preoperative and postoperative cortisol levels for any of the groups. Preoperative, intraoperative, and postoperative systolic blood pressure, diastolic blood pressure, and pulse are 13 November 2013 Page 8 of 14 ProQuest
  • 11. presented in Table 4. There were no significant differences among the groups in mean preoperative, intraoperative, or postoperative systolic blood pressure, diastolic blood pressure, or pulse. Examining the differences among preoperative, intraoperative, and postoperative systolic blood pressure within each group revealed that mean intraoperative systolic blood pressures were significantly lower than mean preoperative systolic blood pressures for the control group (F^sub 2,24^ = 4.58, P = .021). Mean intraoperative diastolic blood pressures were significantly lower than mean preoperative diastolic blood pressures for the massage with music group (F^sub 2,24^ = 5.93, P = .008) and significantly lower than mean postoperative diastolic blood pressure (F^sub 2,22^ = 5.39, P = .012) for the control group. No significant differences were found among the groups for pain medication received postoperatively (X^sup 2^^sub 3^ = 3.25, P = .355). DISCUSSION The results of the study were similar to previous research findings demonstrating that patients who experienced anxiety, stress, or pain exhibited a reduction in these symptoms when music or music with massage was provided.10-12,20,22 This pilot study demonstrated a significantly lower anxiety response postoperatively in each group. The control group also demonstrated a significantly decreased level of anxiety, which could have been associated with a sense of relief that the surgery was finished. The stress hormone cortisol did not decrease significantly within or among the groups, although previous research studies reported decreases in cortisol levels after an intervention of music or massage.12,16 Furthermore, this pilot study did not reflect differences in pain medication patients received in the PACU. A decreased need for pain medication or decreased pain response after the provision of music or massage, however, has been reported in other studies.12,18,21 13 November 2013 Page 9 of 14 ProQuest
  • 12. The interventions in this pilot study were provided before surgery. In some studies, interventions were provided during the postoperative period in the PACU. The patients in this study also did not select the music for intervention, which, based on the literature, may make a difference in decreasing anxiety, blood pressure, heart rate, and respiration.3,24 The control group also demonstrated significantly lower systolic blood pressures intraoperatively compared to preoperative baseline measurements and significantly lower diastolic blood pressure postoperatively compared to intraoperative measurements. This could have resulted from the investigator's presence during the preoperative and postoperative period, anesthesia medications, or relief that surgery was finished. The mean postoperative prolactin levels were significantly higher than the mean preoperative levels for each group. Prolactin levels are known to increase during the physiological response to stress and increased mental vigilance; however, the significance and effects of the increase in prolactin are mostly unknown.28,29 Prolactin is known to elevate with general anesthesia. In one study, a five-fold increase in prolactin was seen during major surgery with general anesthesia.30 A more recent study demonstrated that serum prolactin significantly increased after the induction of general anesthesia.31 The significant elevations of prolactin demonstrated in all groups may have been influenced by both the physical and psychological aspects of the surgical experience and the use of general anesthesia in some procedures. This study indicates the need to continue to establish empirical data to support the implementation of interventions, such as massage and music therapy, to decrease patients' anxiety, cortisol and prolactin levels, and hemodynamic measures. LIMITATIONS Limitations of this study include its small sample size and that no measures were taken to ensure interrater reliability between the investigator and the research assistant during data collection. Participants underwent different types of surgery, which could contribute many uncontrolled variables. Certain types of surgery may be perceived as more invasive than others, and, therefore, may have increased anxiety. Differences in types of surgeries also could contribute to different levels of postoperative pain. The lengths of surgeries also were 13 November 2013 Page 10 of 14 ProQuest
  • 13. different. Anesthesia used in the various procedures included general, spinal, regional, and local. As a result, some patients were more aware of their surroundings than others, and this could have resulted in increased or decreased anxiety. RECOMMENDATIONS FOR FUTURE RESEARCH A more focused study could offer more meaningful results. A study that includes participants undergoing only one type of surgery could control for the type of procedure, sample, length of surgery, type of anesthesia, and similar postoperative recovery time. The interventions in this study were performed preoperatively. It would be interesting to examine the effects of such interventions both preoperatively and postoperatively to determine if the treatments would influence the time it would take to reduce prolactin to a hemostatic level. A power analysis will be performed to determine the sample size needed for additional studies based on future hypotheses. CONCLUSION Outcomes related to the stress response could be detrimental to patients undergoing surgery; therefore, clinical research to identify interventions (eg, massage therapy, music therapy, guided imagery, hypnotherapy) that could decrease the stress response is valuable. Nurses are with patients during each phase of the surgical experience. Nurses, therefore, must have an understanding of the need to offer noninvasive, cost-effective approaches to improving patients' surgical experiences and improving preoperative, intraoperative, and postoperative outcomes. Sidebar Previous studies have demonstrated therapeutic benefits of massage in terms of decreased anxiety, stress, and pain. Sidebar Empirical data may provide justification for offering massage and music therapy as a preoperative standard of care. Sidebar State anxiety was defined as the intensity of apprehensive feelings experienced at a particular moment as measured by the Spielberger State-Trait Anxiety Inventory six-item short form. Sidebar This study indicates a continued need to establish data supporting implementation of interventions to decrease patients' anxiety, cortisol and prolactin levels, and hemodynamic measures. Footnote NOTES 1. R J Hinojosa, "A research critique. Intraoperative music therapy: Effects of anxiety, blood pressure," Plastic Surgical Nursing 15 (Winter 1995) 228-231. 2. L L Henry, "Music therapy: A nursing intervention for the control of pain and anxiety in the ICU: A review of the research literature," Dimensions of Critical Care Nursing 14 (November/December 1995) 295-304. 3. A Eisenman, B Cohen, "Music therapy for patients undergoing regional anesthesia," AORN Journal 62 (December 1995) 947-950. 4. K M Miller, P A Perry, "Relaxation technique and postoperative pain in patients undergoing cardiac surgery," Heart &Lung 19 (March 1990) 136-146. 5. M Ching, "The use of touch in nursing practice," The Australian Journal of Advanced Nursing 10 (JuneAugust 1993) 4-9. 6. S Watson, S Watson, "The effects of massage: An holistic approach to care," Nursing Standard 11 (Aug 13, 1997) 45-47. 7. C J Stevenson, "The psychophysiological effects of aromatherapy massage following cardiac surgery," 13 November 2013 Page 11 of 14 ProQuest
  • 14. Complementary Therapies in Medicine 2 (January 1994) 27-35. 8. B Kaada, O Torsteinbo, "Increase of plasma beta-endorphins in connective tissue massage," General Pharmacology 20 no 4 (1989) 487-489. 9. M Nixon et al, "Expanding the nursing repertoire: The effect of massage on postoperative pain," The Australian Journal of Advanced Nursing 14 (March-May 1997) 21-26. 10. C Dunn, J Sleep, D Collett, "Sensing an improvement: An experimental study to evaluate the use of aromatherapy, massage and periods of rest in an intensive care unit," Journal of Advanced Nursing 21 (January 1995) 34-40. 11. J Fraser, J R Kerr, "Psychophysiological effects of back massage on elderly institutionalized patients," Journal of Advanced Nursing 18 (February 1993) 238-245. 12. T Field et al, "Burn injuries benefit from massage therapy," The Journal of Burn Care &Rehabilitation (May/June 1998) 241-244. 13. P van der Riet, "Effects of therapeutic massage on pre-operative anxiety in rural hospital: Part 1," Australian Journal of Rural Health 1 (August 1993) 11-16. 14. P van der Riet, "Effects of therapeutic massage on pre-operative anxiety in rural hospital: Part 2," Australian Journal of Rural Health 1 (August 1993) 17-21. 15. G R Watkins, "Music therapy: Proposed physiological mechanisms and clinical implications," Clinical Nurse Specialist 11 (March 1997) 43-50. 16. R Spintage, R Droh, "Effects of anxiolytic music on plasma levels of stress hormones in different medical specialties," in The Fourth International Symposium on Music-Rehabilitation and Human Well-being: August 15, 1985, New York City, ed R R Pratt (Lanham, Md: University Press of America, 1987) 88-101. 17. S K Stone et al, "The effects of music therapy on critically ill patients in the intensive care setting," (Abstract) Heart &Lung (May 1989) 291. 18. K Johnston, J Rohaly-Davis, "An introduction to music therapy: Helping the oncology patient in the ICU," Critical Care Nursing Quarterly 18 (February 1996) 54-60. 19. K B Gaberson, "The effects of humorous and musical distraction on preoperative anxiety," AORN Journal 62 (November 1995) 784-791. 20. K Stevens, "Patients' perceptions of music during surgery," Journal of Advanced Nursing 15 (September 1990) 1045-1051. 21. L Heitz, T Symreng, F L Scamman, "Effect of music therapy in the postanesthesia care unit: A nursing intervention," Journal of Post Anesthesia Nursing 7 (February 1992) 22-31. 22. S Barnason, L Zimmerman, J Nieveen, "The effects of music interventions on anxiety in the patient after coronary artery bypass grafting," Heart &Lung 24 (March/ April 1995) 124-132. 23. M Good, "A comparison of the effects of jaw relaxation and music on postoperative pain," Nursing Research 44 (January/February 1995) 52-57. 24. P Augustin, A A Hains, "Effect of music on ambulatory surgery patients' preoperative anxiety," AORN Journal 63 (April 1996) 750-758. 25. J F Marek, M J Boehnlein, "Preoperative Nursing," in Medical Surgical Nursing: Concepts and Clinical Practice, sixth ed, W J Phipps, J K Sands, J F Marek, eds (St Louis: Mosby, 1999) 479. 26. T M Marteau, H Bekker "The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI)," The British Journal of Clinical Psychology 31 (September 1992) 301-306. 27. Tuber's Cyclopedic Medical Dictionary, 19th ed (Philadelphia: F A Davis Co, 2001) 492, 587, 1761, 1794, 2126. 28. C J Merkle et al, "Structural and functional effects of high prolactin levels on injured endothelial cells: Evidence for an endothelial prolactin receptor," Endocrine 13 (August 2000) 37-46. 29. U Anegg et al, "Stress-induced hormonal and mood responses in scuba divers: A field study," Life Sciences 13 November 2013 Page 12 of 14 ProQuest
  • 15. 70 (April 26, 2002) 2721-2734. 30. G L Noel et al, "Human prolactin and growth hormone release during surgery and other conditions of stress," The Journal of Clinical Endocrinology and Metabolism 35 (December 1972) 840-851. 31. J M Brand et al, "Upregulation of IFN-gamma and soluble interleukin-2 receptor release and altered serum cortisol and prolactin concentration during general anesthesia," Journal of Interferon and Cytokine Research 21 (October 2001) 793-796. AuthorAffiliation Laura D. McRee, RN; Stacie Noble, MD; Alice Pasvogel, RN AuthorAffiliation Laura D. McRee, RN, MSN, LMT, is a clinical assistant professor, University of Arizona College of Nursing, Tucson. Stacie Noble, MD, is a clinical instructor, department of anesthesiology, University of Arizona College of Medicine, Tucson. Alice Pasvogel, RN, PhD, is a senior research specialist, University of Arizona College of Nursing, Tucson. Subject: Music therapy; Anxieties; Physical therapy; Medical research; MeSH: Adult, Aged, Anxiety -- physiopathology, Blood Pressure -- physiology, Humans, Hydrocortisone -blood, Middle Aged, Pilot Projects, Postoperative Period, Preoperative Care -- psychology, Prolactin -- blood, Pulse, Random Allocation, Treatment Outcome, Anxiety -- therapy (major), Massage (major), Music Therapy (major), Preoperative Care -- methods (major) Substance: Hydrocortisone; Prolactin; Publication title: Association of Operating Room Nurses. AORN Journal Volume: 78 Issue: 3 Pages: 433-42, 445-7 Publication year: 2003 Publication date: Sep 2003 Year: 2003 Publisher: Elsevier Limited Place of publication: Denver Country of publication: United States Publication subject: Medical Sciences--Nurses And Nursing ISSN: 00012092 Source type: Scholarly Journals Language of publication: English Document type: Clinical Trial Accession number: 14507122 ProQuest document ID: 200730865 Document URL: https://search.proquest.com/docview/200730865?accountid=46437 13 November 2013 Page 13 of 14 ProQuest
  • 16. Copyright: Copyright Association of Operating Room Nurses, Inc. Sep 2003 Last updated: 2013-02-06 Database: ProQuest Health & Medical Complete,ProQuest Research Library _______________________________________________________________ Contact ProQuest Copyright © 2013 ProQuest LLC. All rights reserved. - Terms and Conditions 13 November 2013 Page 14 of 14 ProQuest