Analysis of The Effect of Music on Preoperative Anxiety in Day Surgery Article by Cooke, Chaboyer, and Hiratos - Coursework Example

Cooke’s, Chaboyer’s, Schluter’s, and Hiratos’ The Effect of Music on Preoperative Anxiety in Day Surgery: A Critical Appraisal: Studies on the impact of music in improving comfort and lowering stress and anxiety levels when used in various clinical settings has been done numerous times already yet appraisals on its value and reliability may be few. To help us decipher some of the complex, complicated and difficult nature of such research, we will use one particular study, The Effect of Music on Preoperative Anxiety in Day Surgery, authored by Cooke, Chaboyer, Schluter and Hiratos (2005). Although the study may be commended for its researchers’ attempt at encouraging future studies in what may be regarded as a very complex and complicated field, a systematic appraisal of such study will help nursing students and practitioners use evidence-based materials to assure utmost patient care. As nursing professionals who provide health and clinical care to patients, it is necessary that our basis of actions meet quality standards and meets best practice. To do so, this paper sought to appraise the paper, particularly what did the researcher do and how did they do it. This critical appraisal ends with a short conclusion on the applicability and relevance of the said paper for their practice in the nursing/patient care profession. Brief Summary and Key Issues This paper has demonstrated that music – apart from other health intervention strategies and methods – can be used in lowering the levels of anxiety or stress for day surgery patients subjected to listen to music as they wait for surgery. While not a pioneering study in the use of music therapy in hospital and patient care, it is however new in its exploration of the effects of such health intervention process on preoperative anxiety. The team of Cooke, Chaboyer, Schluter and Hiratos (2005) were keen in addressing one of the most common nursing intervention method with regard to anxiety brought about by the numerous clinical procedures that patients are subjected to. Particular in this study was the frame of preoperative surgery or the lull in time while patients wait for their operation. Over the last two decades, several studies have raised the impact of anxiety to patient – often manifested both psychologically and physically – when undergoing clinical or patient care procedures. The results are often found bearing negating patient outcomes. Thus, in Cooke’s et. al.’s study, highlighted was the perception of anxiety, which may be exacerbated more during day operations due to patient’s very little orientation to the surgical environment and the waiting time. Moreover, patients and nurses are concerned that anxiety may be addressed effectively through cooperation and intervention from both parties, respectively. In fact, day surgeries have increased throughout the decades in Australia, United States, and United Kingdom brought about by the advances in the technical and anesthetic progresses. The researchers have also underscored the use of other intervention approaches on preoperative anxiety such as massage, aromatherapy, reflexology, guided imagery and hypnosis in promoting relaxation. The paper, however, found that these intervention procedures are limited, and unlike music, these are not self-administered. Finally, the paper indicated that studies conducted were often limited by methodological issues, which in effect affect any generalizability of results. The researchers identified among these limiting factors – a) sample sizes are small; b) self-report approaches lacked rigor, and; c) randomization was not always evident or randomization was not used. Appraising the Study At face value, the authors were keen in understanding the underlying phenomenon that arise when music is used in patient care practices, particularly in pushing down anxiety levels among patients who seek daytime operations. The pursuit of the study is evidently driven by the outcomes of previous researches conducted on the impact of music among several clinical situations, which were found insufficient in providing conclusive outcomes due to several methodological limitations. Although in most nursing studies, the quantitative approach is widely preferred than the quantitative research (Justham 2006), the use by the researchers of quantitative design was logical albeit not always the most convenient approach. The field of nursing is most often influenced by patient-centric, holistic and humanistic values (Parahoo, 2006) yet this study is interested in finding the effectiveness of treatment that the qualitative approach will not provide because subjective beliefs of individuals could be misleading (Hemingway & Brereton, 2009). In effect, the need to provide quantifiable results or outcomes far outweighed the need to look for quality in order to minimize performance bias. Judging the study’s literature study, the researchers logically escalated the issue at hand: that anxiety that patients experience in several clinical setting may be addressed, and the use of music may be one of the keys to taming it or conquering perceptions of anxiety and fear. Their review of literature and studies showed the extent of the researchers’ mastery of the issue at hand yet offers nothing new in opening new branch of studies that will further support their arguments and projected outcome. The researchers suggest that studies on the positive effect of the use of music in various hospital setting since the early 1990s may already be numerous but often offer limited outcomes because of the very little ambition of the past researches. Cooke’s et. al. study indicated the significance of their research among recent and past researches done, citing that the context of day surgery have evolved throughout the years. In various clinical interventions conducted to address preoperative surgeries, the researchers have demonstrated competence in synthesizing numerous studies about several health intervention’s role in reducing patient’s anxiety. The team of Cooke are confident that their research is necessary and timely and backed up their assumptions with several theoretical frameworks it deemed related in its pursuit. The paper is quite focused in its goal – to test the hypothesis that daytime patients who listen to music before their surgery stand greater chance of diminishing the levels of anxiety as against those who receive routine care. The single-mindedness of this paper’s objective paved the way for researchers to investigate with full concentration the ideals of the study. On the other hand, the drawbacks of their rationale in pursuing only one goal or objective is the limited result it will offer in understanding the use of music as a health intervention approach. By delimiting the goal, the researchers sacrificed comprehensiveness, integrity and even credibility in some respect. What the research could have achieved by extending its vision to also investigating not only the effect of music before surgical procedures but also during and after, may have been the prospect that it could have opened even wider horizon for future research or adoption in the nursing practice if deemed successful. As a whole, the paper’s approach and style are easy to the eyes not only among nursing practitioners and students, but also to non-medical or non-nursing readers. It is apparent that extra care were employed by the researchers in developing their thesis, building the foundation of their study through various review of literature and studies, and the discussion of the results to make reading their paper accessible to everyone. The authors’ lucid and sparse style helps in gradually building the importance of their studies for present and future researchers in this field. Appraising Research Components of the Study The study conducted in the early part of 2004 took place in an adult surgical care unit identified to be handling or providing day surgery, such as: orthopedic surgery, cystoscopy and biopsy. The types of services that the surgical clinic offers are considered minor procedures and could deliver a very limited insight to the aspect being investigated. Future studies may consider bigger surgical hospitals were major operational procedures are offered like caesarian, transplantations, and others. The size of the sample - between 11 and 457 – were generated via a computer system through permuted block random assignments to intervention and placebo or control groups by gender. It will be noted how the study maintained its goal of carefully allotting participants to each group. It was further revealed that such procedure was concealed among the researchers so that the likelihood of selection bias was avoided (Clarke & Oxman 2001). To keep the study meet these criteria, a biostatistician and research assistant who are not part of the data collection held the randomization procedures. After the conduct of eligibility procedures, 199 were considered included in the study. Out of the 199 participants who met the inclusion criteria, there are 19 who declined to participate, which resulted in a total of 180 participants who agreed to take both the pre- and post-test. For each treatment group, there are 60 participants who were randomized to each group with 30 males and 30 females each. This size was far larger than previous studies conducted with regard to this subject, a wide adjustment that helped the researchers arrived at a more generalizable outcome. Participants recruited for the tests are day patients whose age are 18 and above, were never subjected to preoperative sedatives and whose anticipated preoperative waiting time is not less than 45 minutes. The goal here is to ensure that equal numbers of each were assured in each group, thereby giving equal chance to patients to undergo the same trials. The setting of age bracket of 18 and above as participants was also in line with the ideals of the study to break free from previous studies’ methodological limits. Impliedly, the researchers adhered to numerous ethical considerations to make the participants freely decide for himself whether he is not coerced to join or were fully aware of the purpose of the investigation (Beauchamp and Childless, 2001). Staff hired by the researchers were also responsible in preparing sequentially-numbered sealed envelopes that contain the assignment for each consenting patient. Participants eligible for the study were asked not to bring friends or family members during the data collection phase. The researchers also excluded participants who did not like music, are hearing-impaired, have difficulty wearing headphones, not proficient in speaking and writing in English, and those undergoing surgery in the eye that their ability to complete a self-administered questionnaire may be impeded. Despite these attempts, the researchers should be alarmed that misinterpretation and ambiguity may still be encountered by participants in completing the questionnaires. Furthermore, future studies should consider non-English speaking patients in the study. By doing so, studies could have understood the role of language barriers in its exploration of the impact of music among people with different cultural background. Using all features of the experiment – intervention, control and randomization – the study used a randomized controlled clinical trial. Participants in the placebo and intervention aspect of the study were provided with a portable CD player and headphones. While participants in the intervention group were granted rights to choose the kind of music they prefer, those in the placebo group were asked to wear headphones yet received no music. Meanwhile, participants of the control group received routine care only. Participants in these three groups were subjected to such test for 30 minutes. Upon completing the 30-minute period of the trial, participants were asked to complete the post-test. One of the challenges encountered during this trial concerns the potential bias that could emerge due to the nature of the intervention whereby participants could not be blinded to group assignment. Bias then is a potential issue. Relevantly, nurses were blinded to group assignment for the intervention and placebo group. Upon the conduct of nursing assessment, participants were told to complete the baseline questionnaire. To gather participant’s response, this study data gathered were coursed through the questionnaires comprised of two sections: demographic data and STAI, Frm Y-1 and State Portion, tools used. The researchers relied on time-tested research tools and this is often not bad considering that introducing or creating new ones may yield outcomes that may be less reliable because such tools were never tested. In research the validity and reliability of tools used are important to ensure that participants are responding or participating without intrusion from outside forces, that may affect their participation, and in turn the outcome of the research. Further Implications The conscious effort to improve clinical standards and procedures is best preached when backed by evidence-based research. Critically-appraised research, such as the one subjected in this study, improves reliability of the body of knowledge being investigated. The paper succeeded in elevating the discourse about the importance of improving patient care through the exploration of more and better way of creatively supporting patient overcome anxiety through intervention programs, which is a critical aspect of nursing care. As students and nursing professionals, such research help clarifies the importance of providing evidence-based care and support for patients since the field of nursing and clinical practice must adhere to strict nursing practice and ethics. It also helps that such appraisal develop the critical thinking faculty of practitioners, in turn making them more careful and sensitive to the necessities of the nursing practice. Overall, patients benefit in the long run when nurses who adhere to the best practice in clinical procedures that are consistently backed by research apply lessons learned. References Burls, A. (2009). “What is Critical Appraisal?” What is …? Series, 2nd Ed. Beauchamp, T., and Childress, J. (2001). Principles of Biomedical Ethics. 5th edn. Oxford: Oxford University Press. Critical Appraisal Skills Programme Checklists. www.phru.nhs.uk/Pages/PHD/resources.htm. Retrieved 4 May 2010. Coughlan, M., Cronin, P., and Ryan, F. (2007). Step-by-Step Guide to Critiquing Research. Part 1: Quantitative Research. British Journal of Nursing, Vol. 16, 11. The CONSORT Statement. www.consort-statement.org/?0=1011. Retrieved 4 May 2010. Hemingway, Pl., Brereton, N. What is Systematic review? London: Hayward Medical Communications, 2009. Cooke, M., Chaboyer, W., Schluter P.and Hiratos, M. (2005). The Effect of Music on Preoperative Anxiety in Day Surgery. Blackwell Publishing Ltd. Read More