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Photo of a girl wearing headphones.

Associate professor Linda Chlan has been studying the impact of music on critically ill patients for almost 10 years.

Music to soothe the stressed-out patient

By Amy Barrett

From eNews, January 24, 2008

There's not much that ventilated patients in an intensive care unit can control. Unable to breathe, swallow, or speak, they experience profound stress and anxiety. The good news, says associate professor Linda Chlan, is that listening to music tailored to the patient's personal and cultural preferences can significantly reduce that anxiety.

"It's about giving patients control in an environment that usually allows them no control over anything," she explains.

Chlan has been studying the impact of music interventions on critically ill patients for nearly a decade. "My background is adult critical care, and I've cared for many ventilated patients over the years," she says. The placement of the endotracheal tube prevents these patients from speaking, she explains, so their ability to communicate is profoundly impaired. Plus, they can't swallow and they can't eat, which is very stressful.

"As a nurse, I always wondered, 'Is there anything we can do besides just giving medications to allay patients' anxiety?'" she says. "I've been particularly interested in studying non-pharmacologic interventions."

In April 2006, Chlan received a four-year National Institutes of Health grant to study anxiety self-management in ventilated patients using music. The project will involve about 200 ICU patients at five Twin Cities sites--the University of Minnesota Medical Center, Fairview; Abbott Northwestern Hospital; United Hospital; North Memorial Medical Center; and the Veterans Administration Medical Center.

"In the NIH project we're studying 'patient-directed music intervention,'" Chlan says. "What we mean by that is patients can listen to whatever music they like, whenever they like, for as long they like, throughout their time on the ventilator in the ICU."

Students assist with the project in a variety of ways. Four research assistants, all School of Nursing graduate students, conduct screening and recruiting, while undergraduates enter data and learn about research. "I invite my advisees to be part of my research projects so they can learn about research outside of the classroom and have a keen awareness of what clinical research is like," says Chlan. "Their contribution is key."

Chlan's team of co-investigators includes Annie Heiderscheit, a board-certified music therapist, who meets with patients to assess their music preferences. She uses a series of yes-no questions to find out if, for example, a patient is a musician, or likes particular instruments or types of music. Heiderscheit uses the information to create customized CDs, which patients are encouraged to listen to while they are in the ICU. Headphones help ensure they can hear the music over the ambient noise. Heiderscheit meets with patients daily to see if they would like any changes in the music.

"As a nurse, I always wondered, 'Is there anything we can do besides just giving medications to allay patients' anxiety?'" she says.

"Preferences change, based on what's going on in your life," says Chlan. "One gentleman was in the ICU for 28 days, and Annie made 16 CDs for him."

Daily anxiety assessments determine the effect of the music intervention. Patients self-report symptoms of perceived anxiety using two paper-and-pencil assessments--the Visual Analog Scale and the Spielberger State Anxiety Inventory. Urine samples are collected every 24 hours and checked for the presence of the stress hormone cortisol; a decrease indicates less stress in response to the intervention.

Results from the first year of the NIH study are still being analyzed, but two of Chlan's previous studies have already demonstrated the effectiveness of music intervention.

"We found quite a profound decline in anxiety in patients who listened to music at least 30 minutes a day," Chlan says. "We found a decreased heart rate, a decreased respiratory rate, and a trend toward decreased cortisol." Nevertheless, music intervention isn't necessarily right for everyone, she cautions. "Not everyone likes music," she says. "Some people would just prefer to read, pray, or meditate."

While speaking at a conference this summer, Chlan met some nurses from Hong Kong who reported that when they had tried playing Western classical music in their ICU, the patients hated it.

"Our ears and brains are trained early on," Chlan says. "Here in the West, the beat and the composition of our music is very different from in the East."

For those who do like music, a radio in the ICU is not the best answer for a therapeutic intervention. Patients need to be able to choose their own music for the music intervention to be effective. "Many ICUs have radios and headphones," Chlan says, "but our intervention is tailored to the individual's preferences."

Patients appreciate the extra effort to help them relax under extremely difficult circumstances. "Patients thank us quite a bit for providing them with music they prefer to listen to," Chlan says. Their gratitude is music to her ears.