Therapeutic Music Intervention to Decrease Chronic Pain

Therapeutic Music Intervention to Decrease Chronic Pain Rate Therapeutic music (TM) intervention is effective in decreasing pain rate to less than three on a pain scale of zero (lowest) to 10 (highest) in people with chronic pain (Gauba et al., 2021). Unrelieved pain is a problem to the people and the public. Pain was inadequately managed with only medications. Music decreases pain rate by activating the cingulo-frontal cortex and pain modulation (Gauba et al., 2021). Residents move their attention away from the negative stimuli to something pleasant and encouraging (Nilsson, 2008). Music occupies the patient’s mind with something familiar and soothing during painful treatments and procedures (Nilsson, 2008). The Project Clinical Problem: Inadequate Pain Control The clinical problem is inadequate pain control greater than three with medications. Improving the knowledge of the American Music Therapy Association (2022) guidelines will be effective for pain control. The facility is managing pain with the usual care and medications. Epidemiology of Pain The key aim of pain management is the provision of individual patient-centered care that focuses on optimizing function and improving activities of daily living (Baldwin, 2022). Pain is one of the most common reasons adults seek medical care in the U.S. Chronic pain led to impaired physical functioning, poor mental health, reduced quality of life, substantial morbidity, and mortality each year. Pain is the leading cause of disability in the U.S. The economic costs of chronic pain are $560 to $635 billion annually (Baldwin, 2021). In 2012, about 25.3 million of the United States (U.S.) adults (11.2 percent) had pain every day for the previous three months and about 40 million adults (17.6 percent) had severe pain (National Center for Complementary and Integrative Health, 2022). Chronic pain is among the most common chronic conditions in the United States (U.S.). In 2019, 50.2 million (20.5 percent) U.S. adults experienced chronic pain and total lost productivity of about $300 billion annually (Brigham and Women’s Hospital, 2021). Planned Project Data The facility uses medication to manage pain but the rates to remained greater than three on a scale of zero (the lowest) to ten (the highest. The healthcare facility provides care to people with special needs including congenital and hereditary, cancers, and hospice conditions. The director of nursing stated that pain management was a priority of the healthcare facility. Residents n depend on the Centers for Medicare and Medicaid Services for their medical costs and feeding. Moreover, people with pain cannot work due to their complex health conditions and have insufficient income. Pain can lead uncooperative attitudes, fear, disability, and inadvertent decannulation. The facility spent an average of $2, 000 every week on pain management. The case manager stated that about six out of 92 residents were sent to emergency room daily due to increased pain. Figure 1 presents the incidence of pain emergency room visits from July to October 2022. There were 281 pain emergency room visit cases during this period, with December having the greatest incident of 51 and July with an average of 43.5. See Figure 1 for the details of the Emergency room visits. The case manager stressed the need for therapeutic music as nonpharmaceutical pain management to decrease pain Unrelieved pain with medications had caused decreased sleep and inadequate rest to the primary caregivers. Decreased sleep and inadequate rest lead to safety issues including increased hospital bills of 2,318.00 and 500.00 dollars for ambulance daily per person. The Planned Project Population The patient population for this project will include females and males aged 18 and above with chronic pain. The nurse-to-patient ratio is one-to-one always. The sources of pain include hereditary, accidents, and neurological conditions; surgical procedures; accidents; and cancer. The LTC facility admits people of all ages with special needs, complex, and chronic health conditions. Inclusion criteria are pain, pain medication orders, aged 18 and above, without hearing impairment, and residing at home or healthcare institutions. Exclusion criteria are people with hearing loss, nonverbal pain infusion, aged below 18 years, and without pain medication orders. Setting: Home Healthcare The setting for conducting this quality improvement (QI) project is at a home health facility in the urban Texas area. The setting has 92 pediatric and adult residents at their homes and group health institutions. Nurses and other health professionals deliver care at the patients’ residence. The nurse-to-patient ratio is one-to-one always. The staff and administrators work at the office. Healthcare professionals include nurse practitioners, registered nurses, and license practical nurses. PICOT In females and males with pain (P), does the use of music therapy as a non-pharmacological measure (I) when compared with no use of music therapy (C), decrease pain (O) in a duration of 11 weeks (T)? The PICOT is an interventional and foreground type of clinical . According to Melnyk and Fineout-Overholt (2019), an intervention clinical is a foreground that asks what intervention most effectively leads to an outcome. The authors further explained that foreground questions can be from scientific evidence about diagnosing, treating, or assisting patients in understanding their prognosis, or their health experience (Melnyk & Fineout-Overholt, 2019). Literature Review The purpose of this review of literature (ROL) is to review and choose the best evidence-based practice literature on the effectiveness of music intervention to decrease pain rate in adults. To gain more knowledge and assistance in formulating an audit checklist tool for music intervention, the author of this project searched for evidence-based practice literature and got twenty of them. Search keywords include chronic pain, music, and decrease pain. After literature search through health research databases, the project author selected and reviewed the best and efficient ten literature including systematic review of two randomized controlled trials (RCTs), evidence-based guideline, mixed RCT, quasi RCT, systematic review, and prospective study. Table 1 is the evidence table and Table 2 is the synthesis matrix of the details of the selected research articles used for the review of literature in this project. Pain is universal and contributes to morbidity, mortality, disability, and health care system burdens (Agency for Healthcare Research Quality, 2020). To gain more knowledge and assistance in formulating an audit checklist tool for the music intervention, the author of this project searched for evidence-based practice literature and got twenty of them. After literature search through health research databases, the project author selected and reviewed the best and efficient ten literature including one systematic review of two randomized controlled trials (RCTs), one evidence-based guideline, one RCT, one mixed randomized clinical controlled trial and quasi-randomized clinical controlled trials, one systematic review of three randomized controlled trials and one prospective study, one systematic review of five RCTs and three quasi-experimental studies, one systematic review and meta-analysis of pre-registered systematic review and meta-analysis, one mixed quantitative and qualitative study, one prospective RCT study, and one quantitative systematic review of 10 randomized controlled trials and quasi-experimental designs. See Tables 1 and 2 for the details of the selected research articles used for the review of literature in this project. Pain affects both patients and their families, leads to anxiety, stress, and poor quality of life (Peng et al., 2019). Varieties of studies have shown that music is effective in decreasing pain rate to less than three. A mixed quantitative and qualitative study conducted by Peng et al.(2019) showed a positive effect of adding music to the standard of care for patients receiving a hospice or palliative care consult. In the Peng et al.(2019) study, live music intervention sessions were implemented. Peng et al.(2019) found significant decreases in pain rate. Having adequate knowledge of music guidelines is significant in pain management (American Music Therapy Association, 2022; Longard et al., 2016) in the age-related factors affect that pain perception. Music has shown to be effective in decreasing pain rate in people at risk of age-related pain including infants and the elderly period. Additionally, although older adults are sensitive to pains, they fail to express them due to certain factors including inability to express pain intensity, not wanting to trouble family members, and impaired cognitive function (Longard et al., 2016). The history of music intervention dates to ancient times to influence human health. In the sixth century, the Greek philosopher Pythagoras, who was considered the founder of music therapy and geometry, believed that music contributed to health. Pythagoras prescribed music and a specific diet to restore and maintain the harmony of the body and soul (Nilsson, 2008). In the 1800s, Florence Nightingale recognized the power of music in hospital wards to aid in the healing process for soldiers injured in the Crimean war. Nightingale also noted the effects of different types of music on pain (Nilsson, 2008). Music was also effective in the Hsu et al. (2022) systematic review of the effect of music on chronic pain in eight studies involving 524 older adults aged 65 and above in Taiwan and United States. The relevant studies followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to identify and select studies. Hsu et al. (2022) concluded that music has the potential to be an effective adjuvant for managing chronic pain in older adults. Additionally, Hsu et al. (2022) noted that the study had clinical relevance for nurses to incorporate music into the care of older adults with chronic pain. Inadequate knowledge of music guidelines can prevent nurses to understand that clients who are weak experience greater pain intensity and defects in the neurological system which influence their pain perception (American Music Therapy Association, 2022). Moreover, clients who tend to distract from pain by various means such as listening to music often experience less pain (American Music Therapy Association, 2022; Longard et al., 2016). People who previously had poor pain management often feel challenged to manage pain if it occurs again (Longard et al., 2016). Healthcare professionals are to possess adequate knowledge of music to instruct population and their primary caregivers. Studies have shown that family support during pain can influence one’s pain experience as love and care from families and friends provide emotional support (Kohler et al., 2020; Longard et al., 2016). In a systematic review and meta-analysis of a narrative synthesis conducted by Kohler et al. (2020) that included thirty studies on music therapy in the psychosocial treatment of adult cancer patients in Germany shows that music therapy overall had positive effects on a broad range of outcomes, with techniques and effects varying in different phases. Additionally, Kohler et al. (2020) noted that effect of TM was effective in oncological curative treatments. A similar study by (Bradt et al., 2016) showed that oncological pains can be managed with adequate knowledge of music in addition to the standard of care. Bradt et al. (2016) study was a randomized and quasi-randomized controlled trials on music interventions for improving psychological and physical outcomes in cancer patients in the U.S. Bradt et al. (2016) found a large pain‐reducing effect in 528 participants of the seven studies. Furthermore, Arruda et al. (2016) conducted a randomized clinical trial (RCT) on the evaluation of the effects of music and poetry in oncologic pain relief. The result of the Arruda et al. (2016 study showed that music is effective in decreasing pain intensity. Music promoted an improvement in pain and depression while poetry promoted an improvement in pain rate and hope (Arruda et al., 2016). TM was also effective in decreasing pain rate in the Gauba et al. (2021) and Sibanda et al. (2019) studies. American Music Therapy Association (2022) guidelines were effective in improving music knowledge for pain management. American Music Therapy Association (2022) Interventions and Recommendations American Music Therapy Association (2022) published guidelines for music listening programs intended to provide guidance to individuals engaging or assisting others in regular music listening to address physiological, psychological, communicative, behavioral, educational, and or wellness needs. It is important to note the difference between personalized music listening (PML), background music listening (BML), leisure music listening (LML), and music listening (ML). Guideline 1: Auditory Safety ML should be delivered at a volume controlled at 65 decibels or lower (American Music Therapy Association, 2022). When ML is to be delivered via headphones, the style of headphones should be selected based upon the listener’s comfort and safety. Bluetooth headphones are recommended for listeners whose safety could be at risk and/or music listening experience could be interrupted by become entangled in headphone wires (American Music Therapy Association, 2022). Listeners with hearing aids and or hearing impairments should have a consultation with their audiologist prior to beginning a regular music listening program (American Music Therapy Association, 2022). Guideline 2: Infection Control Safety (a) For cleaning and disinfecting, use EPA-registered, disposable disinfectant wipes, ultraviolet-C disinfection wands, or follow any other sanitary procedures provided by a person’s physician or facility infection control staff. (b) Cleaning and disinfecting are recommended: when visibly soiled, before and after each use if person has an infection and or is on infection control precautions, when equipment is being transferred between individuals for use, when a person has been traveling with their equipment and when it may have come into contact with contagious diseases (American Music Therapy Association, 2022). Guideline 3: Music Content Considerations American Music Therapy Association (2022) recommended that song selections for ML, especially PML, should take into consideration lyric content that may promote or suppress healthy behaviors and information should be obtained on any songs, lyrics, subjects that should be avoided and note any negative reactions to song lyrics should they occur. (a) Individuals with a history and or predisposition for addictions and or unhealthy behaviors, or who have a history of trauma, are consult with their physicians, counselors, music therapists and other treatment team members and practice caution when selecting ML, and especially PML, songs associated with and/or containing lyrics pertaining to those addictions, behaviors, or memories. (b) Use of ML songs, especially PML songs, known or likely to cause intense emotional and cognitive responses are not recommended for use outside of a treatment plan with a qualified healthcare professional (American Music Therapy Association, 2022). Guideline 4: Health Considerations (a) Physiological Considerations While selecting music to match individuals’ current mood can be effective, it is important that the music does not prohibit the individual from changing moods and experiencing the full spectrum of feelings and emotions. Individuals with mental health diagnoses that present with hyperactivity and or mania should avoid selecting songs or playlists of songs that only express and elicit fast-paced sound and activity, high energy and/or excitement. ML, whether individually or in groups, may be accompanied by other experiences (such as art composition, moving, story composition, or lyric discussion) designed to give form to thoughts, impressions, or emotions generated by the music (American Music Therapy Association, 2022). (b) Cognitive, Communicative, and Sensory Considerations Individuals with cognitive and sensory processing deficits should have PML delivered in consideration of their environmental stimuli, physiological stimuli, and their ability to neurologically process the music stimuli within their current state of recovery from injury or disease. An individual experiencing severe and or chronic pain may demonstrate hypersensitivity to music stimuli and therefore may require frequent adaptations in delivery of music stimuli to meet their changing ability to process varying amounts and types of stimuli and to benefit from PML (American Music Therapy Association, 2022). Individuals with seizure disorders may find that some music triggers seizures. Individuals with music-induced seizures should consult with a music therapist and or their healthcare team when planning to engage in ML, especially PML (American Music Therapy Association, 2022). Project In female and male aged 18 and above and with pain, does the use of music therapy as a non-pharmacological measure, decrease pain rate in a duration of 11 weeks? Therapeutic music intervention will be used to decrease pain rate. The project that asks what intervention most effectively leads to an outcome (Melnyk & Fineout-Overholt, 2019). The questions can be from scientific evidence (Melnyk & Fineout-Overholt, 2019). Objective The objective of this project proposal is to improve the quality of pain management for the LTC residents suffering from chronic pain by adding nonpharmacological TM to the list of activities available to the residents on the nursing unit. Framework: John Hopkins Nursing Evidence-Based Practice Model The best evidence-based practice EBP framework for this practice setting is the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model. JHNEBP is clinician-focused, allowing rapid and appropriate application of current research and best practices. The framework simplifies the evidence-based practice EBP process and cultivates a culture of care based on evidence (Melnyk & Fineout-Overholt, 2019). The model has three overall steps including practice , evidence, and translation. The (JHNEBP) model directive tools are intended for practicing clinicians working individually or in a group to address clinical inquiries (Dang, 2022). John Hopkins Nursing model has three major components including research, practice, education, internal, and external factors (John Hopkins University, 2021). JHNEP model will guide the project in the practice setting by utilizing its problem-solving approach to clinical decision-making. The model accelerates research into nursing practice and promotes nursing autonomy, leadership, and engagement with colleagues. JHNEP model combines the nursing process of the American Nursing Association (ANA) standards of practice, critical thinking, and research utilization (John Hopkins University of Medicine, 2021). JHNEP model is a problem-solving approach to clinical decision-making. The nursing process is the common thread that unites different types of nurses who work in varied areas (American Nurses Association, n.d.). The setting follows the nursing process which is the essential core of practice for the registered nurses to deliver holistic and patient-focused care (American Nurses Association, n.d.). On patient admission, nurses follow the five steps of the nursing process including assessment, diagnosis, planning, implementation, and evaluation (American Nurses Association, n.d.). The Strengths and Limitations of the JHNEBP Model The JHNEBP model is a powerful problem-solving approach to clinical decision-making and is accompanied by user-friendly tools to guide individual or group use (John Hopkins University of Medicine, 2021). The model ensures that the latest research findings and best practices are quickly and appropriately incorporated into patient care. The JHNEBP model is designed specifically to meet the needs of the practicing nurses. It uses a three-step process called practice , evidence, and translation (PET). Additionally, the JHNEBP model enables consistency of care, increases confidence in decision making, provides guidelines for further research, contributes to the science of nursing, and provides better information to practitioners (John Hopkins University, 2021). Explanation: Conclusion This quality improvement (QI) project will improve the knowledge of therapeutic music intervention and decrease pain rate. Pain treatments are costly to the people and the public and has negative effects on income and employment. Pain causes sleep disruptions, disability, death, and unhappiness. Having adequate knowledge of the use of music guidelines in pain management of children and adults (Gauba et al., 2021). Music has positive effect on pain and focuses the patient’s attention away from the negative stimuli to something pleasant and encouraging (Nilsson, 2008). Music occupies the mind with something familiar and soothing during painful procedures and treatments. Additionally, patients can focus their awareness on the music to aid relaxation (Nilsson, 2008). SCIENCE HEALTH SCIENCE NURSING NURS 6326

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