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  1. 1. INTRODUCTIONIf burn injuries in themselves in themselves are not the most painful trauma person can sustainthen they likely reach this status once the nature of the treatment is considered.Pain is a feeling triggered in the nervous system. Pain may be sharp or dull. It may come andgo, or it may be constant. Pain can be helpful in diagnosing a problem. Without pain, youmight seriously hurt yourself without knowing it, or you might not realize you have a medicalproblem that needs treatment. Fortunately, there are many ways to treat pain. Treatmentvaries depending on the cause of pain. Pain relievers, acupuncture and sometimes surgery arehelpfulLike emotions, perceptions of pain differ from other senses such as sight or vision becausethey do not require a particular environmental energy, and the identity of the individual andtheir personal belief and value systems appear to affect how pain is evaluated andinterpreted.Tissue damage at the burn site is the predominant mechanism of pain and suffering in thesepatients. Excessive pain can increase the amount of time it takes caregivers to complete thewound care, and can increase how long the patient remains in the hospital before discharge.Pharmacologic treatment with potent opioids, anxiolytics, and other agents (e.g., ketamine) isthe first line of therapy. However nonpharmacologic methods of treating burn pain are alsoextremely useful.Indian classical Ragas have been acclaimed by Vedic science to have healing effects. Musichas frequently been used as a therapeutic agent from the ancient times. In India, music is akind of yoga system through the medium of sonorous sound, which acts upon the humanorganism and awakens and develops their proper functions to the extent of self-realization,which is the ultimate goal of Hindu Philosophy and religion ] Melody is the keynote of IndianMusic. The Raga is the basis of melody. Various Ragas have been found to be veryeffective in curing many diseases related to the Central Nervous System. Before using musicas Therapy, it must be ascertained which type of music is to be used. The concept of MusicTherapy is dependent on correct intonation and right use of the basic elements of music. Suchas notes [swara] rhythm, volume, beats, and piece of melody.There are countless Ragas of course with countless characteristic peculiarities of their own.That is why we cannot establish a particular Raga for a particular disease. Different types ofRagas are applied in each different case. Classical music with its unique swara/note structureensures calm and cozy mind by exposure and subdues the emotion provoking situations.Music plays an effective role in subduing the so-called emotional imbalance.Research has shown that music has a profound effect on your body and psyche.
  2. 2. NEED FOR THE STUDYBurn injuries are a major medical condition, often resulting in hospital admissions, surgeries,and extensive therapies. Burns is one of the most painful types of trauma, and painmanagement in all aspects of recovery. Patients with burns experience “resting pain”secondary to tissue damage and “procedural pain” caused by interventions such as wound careand range-of-motion exercises. In addition, repetition of these painful procedures often createsanticipatory anxiety for patients with burns Research has demonstrated that anxiety and painare interrelated and that an individual’s level of anxiety directly influences his or herperception of pain. This concept is supported by the gate control theory of pain, which statesthat there is a gating mechanism in the nervous system that can block the transmission of painsensation at the level of the spinal cord. The gate control theory supports the use of music as adistraction from noxious input. For example, the gate control theory suggests that cognitiveprocesses, such as relaxation, can exert control over painful stimuli. Additionally, anxietycreates a state of physiological stress arousal that is manifested by increased activation of thesympathetic nervous system. Literature shows that sympathetic nervous system activity can beeffectively decreased through the use of relaxation music.Specifically, pain control is a common obstacle limiting various therapy and treatments.Patients with burns experience “resting pain” secondary to tissue damage and “proceduralpain” caused by interventions such as wound care and range-of-motion exercises.Although the type of pain is generally shorter in duration, it is greater in intensity.Management of this procedural pain is critical for optimal outcomes in therapy. Opioid drugsare the primary pharmacological treatment for pain management of burn injuries, but theyoften do not provide complete alleviation of pain during therapeutic interventions High dosesof opioid drugs may also limit a patient’s ability to function. In addition, repetition of thesepainful procedures often creates anticipatory anxiety for patients with burns. Research hasdemonstrated that anxiety and pain are interrelated and that an individual’s level of anxietydirectly influences his or her perception of pain. This concept is supported by the gate controltheory of pain, which states that there is a gating mechanism in the nervous system that canblock the transmission of pain sensation at the level of the spinal cord.Additionally, anxiety creates a state of physiological stress arousal that is manifested byincreased activation of the sympathetic nervous system. Literature shows that sympatheticnervous system activity can be effectively decreased through the use of relaxation music.Historically, music has been used in medical settings, such as hospital waiting rooms anddental offices, to promote relaxation. The use of therapeutic music in controlled environmentsfor specific patient populations and procedures. Research has shown that music has aprofound effect on your body and psyche. In fact, there’s a growing field of health careknown as Music Therapy, which uses music to heal. Those who practice music therapy arefinding a benefit in using music to help cancer patients, children with ADD, and others, andeven hospitals are beginning to use music and music therapy to help with pain management,to help ward off depression, to promote movement, to calm patients, to ease muscle tension,and for many other benefits that music and music therapy can bring. This is not surprising, asmusic affects the body and mind in many powerful ways.
  3. 3. PROBLEM STATEMENTA study to assess the effect of music therapy on selected parameters during wound carein patients with burns injury in selected hospitals.OBJECTIVES: • To assess the intensity of pain before and after music therapy in patients with burn injury. • To assess the physical parameters before and after music therapy in patients with burn injury. • To assess the physiological parameters before and after music therapy in patients with burn injury. • To find assess the behavioral responses before and after music therapy in patients with burn injury. • To assess the correlation between music therapy and selected variables such as age, depth of wounds.OPERATIONAL DEFINITIONSAssessAccording to Oxford dictionary, “assess” means to evaluate the value, importance or qualityof something. In this study assess means to find out the effectiveness of the music therapy beingprovided during wound care to patients with burn injury..EffectAccording to Chamber’s 20th century dictionary, “effect” means result of an action or animpression produced.In this study effect means a change produced in selected parameters i.e physical parameters,physiological parameters and behavioral response.ParametersAccording to Oxford dictionary, “parameters” means a characteristic or feature which ismeasurable or quantifiable.In this study parameters means factors which determine a system and its behavior and arevaried, this includes physical, physiological and behavioral parameters.
  4. 4. Physical parameters:According to Banthams Medical dictionary’ “Physical” means concerning or pertaining to thebody.In this study physical parameters include: facial expressions, clenching of jaws, moving ofextremities, wrinkling of forehead, closing eyes, perspiration, fisting of hands etc.Physiological parametersAccording to Banthams medical dictionary, physiological means physical functions of thebody.In this study physiological parameters include pain intensity measured using numerical painscale, heart rate, blood pressure and respiration.Behavioural responses According to Tabers medical dictionary,”behavior” is a manner in which one acts or they arethe actions or reactions of individual under specific circumstances.Responses are feelings, movement caused by stimulus or influence.In this study behavioural response include responses like groaning, crying , screaming etc.Music therapyAccording to Oxford medical dictionary, “music” means the art of combining vocal orinstrumental sounds or both to produce beauty of form, harmony and expression of emotion.According to Concise medical dictionary, “therapy” means treatment of physical, or mentaldisorders, other than by surgery.In this study music therapy refers to the use of structured music in the form of combinationof western beats and Indian ragas of varying sound frequencies between 30- 60 Hz with astereophonic effect. It is a total 22min composure which would be repeated variablydepending on the duration of wound care. The music will be played starting from 15minsbefore wound dressing , throughout wound dressing and would be continued for 15 mins afterwound dressing using walkman and overhead phones or handsets.Wound careA wound is a break in the skin (the outer layer of skin is called the epidermis). Wounds areusually caused by cuts or scrape. Wound care are steps taken to ensure that a wound healscorrectly and does not get infected. In this study wound care involves all the processes involving removal of previousdressing, soaking of wound, cleansing of wound, application of medicines and covering ofwound. These wound dressing procedures are done regularly without anesthesia.Burns According to Blakistons New Gould medical dictionary , a burn is a tissue reaction or injuryresulting from contact with heat, chemicals , radiation, electricity or friction.
  5. 5. In this study burns means injury to the skin produced by thermal, chemical, electricityradiation or friction causes ,with first and second degree burns only.First-degree burns affect only the outer layer of the skin (epidermis). They cause pain,redness, and swelling. Second-degree (partial thickness) burns affect both the outer andunderlying layer of skin(epidermis and dermis). They cause pain, redness, swelling, andblistering.ASSUMPTIONS • First and second degree burns are painful. • Procedure of changing the wound dressing causes pain. • Music is an accepted form of alternative therapy. • Music may have influence on pain during wound care in patients with burn injury. • Physiological parameters under study may vary from individual to individual. • Duration of dressings vary from patient to patients.Variables:Independent variable: Music therapyDependent variable: Selected parameters like physical parameters, physiologicalparameters and behavioural resposes.RESEARCH METHODOLOGYResearch approachIn this study descriptive evaluative approach will be used.Research designIn this study one group pre test – post test research design would be used.Setting The selected setting would be various hospitals across Mumbai which specially cater topatients with burn injuries.PopulationThe population consists of all the patients with burns injury admitted in various hospitals.
  6. 6. Sample In this study the sample consists of all patients with first and second degree burns who undergo regular wound dressing and are admitted in various hospitals across Mumbai and who fulfil the inclusion criteria. Sample size The total sample size consists of total 30 patients. CRITERIA FOR SAMPLE SELECTION INCLUSION CRITERIA • Patients with first and second degree burns injury . • Patients with burns injury who require daily dressing and wound care. • Patients who are willing to participate in the study. • Patients who can understand Hindi, Marathi or English. EXCLUSION CRITERIA • Patients with burn injury who have any hearing problem or ear infections or any external burn injury to ear. • Third and fourth degree patients with burn injury. • Patients with burns injury who are unconscious or intubated. TOOL AND TECHNIQUE Tool: 1) Observation checklist 2)Interview. Technique: 1) observation 2) semi structured interviewAnalysis and interpretation of data: • Frequency percentage.
  7. 7. • Hypothesis testing: Paired t- testHYPOTHESIS: • Ho: There is no significant effect of music therapy on pain during burns wound care. • H1: There will be minimum variation in physical and physiological parameters in patients receiving music therapy. • H2: Patients in the study report pleasant emotions experienced with music therapy during burns wound care. • H3: There will be a reduction in frequency of analgesics received by patients before and during and after burns wound care.DELIMITATIONS • As pain assessment is based on observations and verbal response some amount of subjectivity is inevitable. • Since the study is being done on a small group the findings of the study cannot be generalized.SCOPE OF STUDY • Music therapy can be used as one of the non pharmacological measures to control pain during burns wound care. • Music therapy can be used as an intervention to reduce pain and anxiety in patients during other painful invasive procedures and conditions. • This study will bring forth the views of the patients regarding acceptance of diversional therapy in reducing physical and emotional tension.
  8. 8. ReseaRchpRoposal
  9. 9. By: ms Juliet meRline