ORIGINAL ARTICLES

Perioperative Music or Headsets to Decrease

Anxiety
Brenda Johnson, BSN, RN, CPAN, Shirley Raymond, BSN, RN, CPAN, Judith Goss, BSN, RN

The ambient noise of monitors, other patients, and staff in the post-
anesthesia care unit/operating room may elevate levels of anxiety. The
purpose of our study was to determine the effect of music versus noise-
blocking headphones on the level of anxiety in women undergoing gyne-
cologic same-day surgery. Institutional Review Board approval was
obtained. The women were approached for consent and randomized to
usual care, music with headphones, or headphones only. Preoperative
and postoperative anxiety was rated on a scale of 0 to 10. Music/head-
phones were continued throughout surgery and removed when Aldrete
level of consciousness equaled 2. The 119 women had a mean age of
38.8 (standard deviation 5 2.2) years. Of interest, 51 (45%) reported
very low preoperative anxiety (0-3/10) and were excluded. All groups ex-
perienced a drop in anxiety from pre- to postoperative status, but the
usual care group had the least improvement (P , .05). The music group
experienced the lowest postoperative anxiety scores; the headphone
group had a greater change overall. Music is a relatively inexpensive in-
tervention, easy to administer, and noninvasive.
Keywords: music therapy, anxiety, perioperative care, research, music,
perianesthesia.
Ó 2012 by American Society of PeriAnesthesia Nurses

PREOPERATIVE PATIENTS FREQUENTLY expe-
rience anxiety. Surgery itself is stressful. Patients
may worry about the outcomes of surgery or the
possibility of complications. In a prospective study
of patients scheduled for outpatient surgery, it was
found that 57% did not feel calm. This number in-
creased to 65% when only women were studied.1
Furthermore, the ambient noise of monitors, other
patients, and staff in the same-day surgery (SDS),
Brenda Johnson, BSN, RN, CPAN, is a Staff Nurse, PACU;
Shirley Raymond, BSN, RN, CPAN, is a Staff Nurse, PACU;
and Judith Goss, BSN, RN, is a Staff Nurse, PACU, The Christ
Hospital, Cincinnati, OH.
Conflict of interest: None to report.
Address correspondence to Brenda Johnson, PACU, The
Christ Hospital, 2139 Auburn Avenue, Cincinnati, OH 45219;
e-mail address: Brenda.Johnson@thechristhospital.com.
Ó 2012 by American Society of PeriAnesthesia Nurses
1089-9472/$36.00
doi:10.1016/j.jopan.2012.03.001
operating room (OR), and postanesthesia care
unit (PACU) may elevate levels of anxiety.2
A review of the literature indicated support for mu-
sic therapy in reduction of preoperative stress and
anxiety. However, randomized control studies
could not be found that incorporated the use of
music during the entire perioperative period.
Also, studies conducted did not differentiate bet-
ween whether anxiety reduction was because of
music or blocking environmental noise.
Literature Review
Music therapy is the process of bringing about
changes from undesirable, unhealthy, and uncom-
fortable conditions to more pleasant ones by the
deliberate use of music.3 Music has played an im-
portant role in health care and healing since the
beginning of recorded history. Mothers have
sung lullabies to soothe their children. Florence

146 Journal of PeriAnesthesia Nursing, Vol 27, No 3 (June), 2012: pp 146-154

PERIOPERATIVE MUSIC
Nightingale stated, ‘‘Unnecessary noise is that
which hurts a patient’’ in her Notes on Nursing
in 1859.2 She goes on to write about the noise of
a whispered conversation creating more harm
than a louder noise. The strain of the sick patient
listening to a conversation that may be concerning
them was considered the worst of offenses. Today,
we need to remember that as more advanced tech-
nology is being used, noise levels also increase.
Music and noise-blocking headphones can be help-
ful tools. Studies have been conducted to validate
the use of music as a therapeutic tool (Table 1).
Three studies in the literature examined the effects
of music on anxiety and pain.4-6 Heiser et al4 studied
a group of patients undergoing a microdiscectomy.
Patients were randomly assigned to music or no mu-
sic, intraoperatively and postoperatively. Pain and
anxiety were measured using a visual analog scale
(VAS). The sample group of 10 used in the study
by Heiser et al was not large enough for statistical
difference. However, all in the music group com-
mented very positively, stating how relaxing the
music was and they would like to listen again.
Nilsson et al5 looked at 75 subjects undergoing
open inguinal hernia repair. Subjects were ran-
domized into three groups, intraoperative music,
postoperative music, and a control group, with
sham CD players. Stress response was assessed
during and after surgery using cortisol and blood
glucose levels. The postoperative music group ex-
hibited decreased anxiety (P , .05) and pain
(P , .01). The intraoperative group experienced
decreased pain postoperatively compared with
the control group (P , .05).
Chlan et al6 studied anxiety and pain in outpatients
undergoing flexible sigmoidoscopy. Spielberger
et al’s State Trait Anxiety Inventory (STAI)7 was
used to measure anxiety. The STAI measures an in-
dividual’s baseline trait anxiety as well as the tem-
porary state anxiety of a given situation. There are
20 statements in each of the state and trait por-
tions. The respondent evaluates each statement
as not at all, somewhat, moderately so, or very
much so. Music was listened to during the proce-
dure. STAI was given preintervention to both
groups. The state portion was also administered
postintervention. A VAS with a rating scale of
0 to 10 was used to measure pain. There was a sig-
nificant difference between the music group and
147
control group in anxiety and pain (P 5 .002 and
P 5 .026, respectively).
Several studies examined only anxiety. Andrada
et al8 studied the anxiolytic effect of listening to
music during colonoscopies. The STAI was given
30 minutes before the procedure and 30 minutes
after. There was a significant decrease in scores
in the experimental group with P , .01.
In the study of a group of 30 men undergoing trans-
urethral resection of the prostate by Yung et al,9 anx-
iety was reduced for the music group, slightly for the
nurse present group, and no reduction was seen in
the control group. Again, with the small group of 30,
although a reduction in anxiety was found, the dif-
ference was not statistically significant.
As a means to reduce the ambulatory surgery pa-
tient’s preoperative anxiety, Augustin and Hains10
investigated music. STAI state portion was taken
on arrival to the center and before surgery. The
music group listened to music 15 to 30 minutes. Al-
though there was a slight reduction in anxiety
from pretest to posttest, the music group had a sta-
tistically significant reduction (P #.005).
Winter et al11 studied 62 women in the SDS gyne-
cology unit. STAI was completed when they arrived
in the surgical holding area and again just before go-
ing to OR. The music group had a reduction of anx-
iety and stress after listening to music in the holding
area. The control group had an increase in anxiety
over the same period. The difference was signifi-
cant, P , .05. All patients recommended that mu-
sic be available for future patients.
Similarly, Hayes et al12 studied 198 subjects to see if
self-selected music would reduce preprocedure
anxiety for patients undergoing colonoscopies
and esophagogastroduodenoscopies. Patients lis-
tened to music 15 minutes before the procedure.
Those randomly assigned to the no music group
had 15 minutes of quiet time. STAI was completed
only postintervention and before the procedure.
There was a significant difference in anxiety
(F 5 7.5; P 5 .007) between the two groups after
controlling for trait anxiety. In addition, patients
who listened to music were asked if they enjoyed
the music and if they felt relaxed after listening.
Ninety-seven percent enjoyed the music, and
89% stated that after listening they felt relaxed.

Table 1. A Review of Research Using Music to Improve Patient Outcomes of Surgery or Special Procedures
Author Study Description
Heiser et al4 Random, controlled experimental
study to test effects of music on
patients who listened to music
intraoperatively or
postoperatively
Nilsson et al5 RCT using sham and regular music
CDs with headphones
intraoperatively or
postoperatively to test stress,
immunity, anxiety, and pain
response during and after
general anesthesia
Chlan et al6 RCT to test the effects of music on
anxiety, discomfort, satisfaction,
and perceived compliance with
colon cancer screening
Andrada et al8 RCT using CDs with headphones
to assess the anxiolytic effect of
listening to music during
colonoscopies
Yung et al9 Quasi-experimental study to assess
anxiolytic effect of music or
nurse presence pre-op
148
Population Sample Measurement Instrument Statistical Significance
10 pts undergoing VAS for pain and anxiety, pain Music group—NS
microdiscectomies medication, questionnaire Questionnaire—very
positive responses
Control group—NS
75 pts undergoing open inguinal Cortisol, blood glucose levels; NRS Intraoperative music group
hernia repair under general for pain and anxiety; BP, HR, Anxiety decreased (P , .05)
anesthesia SpO2 Pain decreased (P , .05)
Pain med decreased (P , .01)
Postoperative music group
Anxiety decreased (P , .05)
Pain decreased (P , .01)
Cortisol decreased (P , .05)
Pain med decreased (P , .05)
64 outpatients undergoing flexible STAI; VAS for pain Music group
sigmoidoscopy Anxiety decreased (P 5 .002)
Pain decreased (P 5 .026)
Control group
Anxiety increased
118 pts receiving prescheduled STAI; BP, SpO2, HR Music group
colonoscopies STAI decreased (P , .01)
BP (NS)
JOHNSON, RAYMOND, AND GOSS
SpO2 (NS)
HR (NS)
30 pts undergoing TURP State portion of the Chinese STAI Music group
SBP decreased (P , .01)
DBP decreased (P , .04)
HR decreased (P , .01)
Anxiety decreased (NS)
Nurse presence
SBP decreased (NS)
DBP increased (NS)
HR decreased (NS)
Anxiety decreased (NS)
 PERIOPERATIVE MUSIC
Control group
SBP increased (P , .01)
DBP increased (NS)
HR increased (P , .01)
Anxiety increased (NS)
Augustin and Quantitative experimental study to 42 ambulatory pts VS; State portion of STAI Music group
Hains10 investigate music reducing pre- Anxiety decreased (P , .005)
op anxiety DBP decreased (P , .005)
HR decreased (0.005)
RR decreased (P , .0005)
Control group
SBP decreased (P , .05)
DBP (NS)
HR (NS)
RR (NS)
Winter et al11 RCT to determine if music reduced 62 SDS GYN pts STAI, BP, HR Music group
anxiety pre-op Anxiety decreased (P , .05)
BP (NS)
HR (NS)
Control group—NS
Hayes et al12 RCT to determine if music reduced 198 pts undergoing EGD and STAI Music group
preprocedure anxiety for GI colonoscopy Anxiety decreased (F 5 7.5
procedures and P 5 .007)
Lukas13 Trial to determine if pts would 31 outpatients undergoing Investigator survey 97% positive experience
perceive listening to music orthopaedic surgery
throughout perioperative
experience as a positive addition
to medication to control pain
and anxiety
Pts, patients; VAS, visual analog scale; NS, not significant; RCT, randomized controlled trial; NRS, numeric rating scale; BP, blood pressure; HR, heart rate; SpO2,
oxygen saturation; SBP, systolic blood pressure; DBP, diastolic blood pressure; VS, vital signs; RR, respiratory rate; STAI, State Trait Anxiety Inventory; TURP, transure-
thral resection of prostate; SDS, same-day surgery; GYN, gynecologic; GI, gastrointestinal; EGD, esophagogastroduodenoscopy.

149
150
Lukas13 surveyed 31 patients’ perceived overall
experiences. This was the only study that allowed
patients to listen to music throughout the whole
perioperative experience. It was not a randomized
control test; however, 97% of the patients did ex-
press a positive experience.
The review of the literature strongly suggests that
the use of music therapy has a direct effect on the
reduction of stress and anxiety. In addition, a posi-
tive relationship in patients’ satisfaction with their
surgical experience after listening to music was
suggested. The studies reviewed, however, were
not clear if results were because of the music or
the blocking of noise.
Purpose
The purpose of this study was to determine the
effect of music versus use of noise-blocking head-
phones on anxiety levels in women undergoing
SDS for gynecologic procedures. This intervention
could in turn improve the overall patient experi-
ence. It was hypothesized that both music and
headphone-only groups would have a decrease in
anxiety, with the greatest decrease in the music
group. Additional information on pain medication
while in PACU was also collected.
Methods
Study Design and Setting
An experimental three-group design was used with
pre- and postmeasurement of anxiety. The Institu-
tional Review Board approved the study, and data
collection was conducted over a 3-month period
in 2009. All data were collected at a single-
institution, a 550-bed tertiary care, community hos-
pital with two surgical areas. An average of 90 cases
per day is seen in the main OR and recovered in a 24-
bed PACU. The PACU serves both inpatient and out-
patient surgical cases. The second operating area is
The Women’s Center, specifically for gynecological
surgery. The Center averages 18 procedures per day
with patients recovered in an 11-bed PACU. Most of
the surgeries are outpatient and include both inva-
sive and noninvasive procedures.
The study was conducted in The Women’s Center
for several reasons: (1) control of participant de-
mographics; (2) tighter study control; (3) studies
JOHNSON, RAYMOND, AND GOSS
have shown that women are more likely to experi-
ence preoperative anxiety than men.1
Instruments
Most studies reviewed used the State Scale of the
STAI. Frequently, only the State Anxiety Score is
used, as it measures anxiety related to the current
situation. However, because the STAI includes 20
questions, it was not used for this study.
An alternative tool, the Rapid Assessment Anxiety
tool, has been used in a previous study of patient’s
preoperative anxiety.1 Developed and validated by
Benotsch et al,14 this single-item numeric rating
scale provides a quick assessment of anxiety that
would be valid and time friendly in the presence
of our fast-paced OR schedules. The tool also pro-
vided the ability to detect change as it rated re-
sponses from 0 (no anxiety) to 10 (most anxiety
possible). Furthermore, it was easy for patients
to understand as it mirrored the usual pain mea-
surement format. The initial work on this tool
demonstrated that it correlated highly with STAI
State Score demonstrating validity (r 5 0.77) in
a sample of 197 patients evaluated preoperatively.
Postoperatively, the same subjects also completed
both anxiety tools with a slight decrease in
strength of relationship (r 5 0.69). The numeric
rating tool also demonstrated sensitivity to change
that mirrored the responsiveness of the STAI
20-item scale.
Inclusion/Exclusion Criteria
All women undergoing gynecologic surgery at The
Women’s Center were included in the study if they
were older than 18 years, undergoing an outpa-
tient procedure, and provided written consent to
participate. Women were excluded if they had
hearing problems that would preclude their ability
to listen to music. A sample size of 120 women was
determined using G Power program. Based on an
alpha of 0.05, power of 0.80, and effect size of
0.25, a total sample of 120 subjects would be
needed for the planned analysis. A repeated mea-
sure analysis of variance with three groups and
two time points was planned to answer the re-
search question and used as the basis for the
power analysis.
PERIOPERATIVE MUSIC 151

Table 2. Comparison of Groups on Demographics and Select Variables of Interest

Demographics Control (n 5 41) Headphones (n 5 35) Music (n 5 43)
Age 38.44 36.83 40.91
Number of medications 2.2 2.11 2.34
Number of previous surgeries 2.41 2.97 2.27
Minutes/day listening to music 194.7 180 212.2
Minutes in operating room 60.7 56.6 60.5
Minutes in PACU until Aldrete 2 17.4 15 21.5
Invasive procedure (%) 48.8 37.1 61.4
Pre-op routine anxiolytics (%) 4.9 5.7 6.8
PACU, postanesthesia care unit.
There were no significant differences among the groups on any of the above variables.

Procedure for Data Collection
The procedure for this study was to initiate the
intervention preoperatively, continue into the
OR, and remain on in PACU until the patient was
awake at a level of consciousness (LOC) of 2 on
the Aldrete score.
The 120 women were approached for consent be-
fore their preoperative medication. After consent,
they were randomized to usual care, music with
headphones, or headphones only. Preoperative
anxiety was obtained using the Rapid Assessment
Anxiety tool, which rates anxiety on a scale of 0 to
10. Patients who received headsets only did not
have an MP3 player attached. The usual care group
received routine care given to all SDS patients.
Those in the music group selected one of three
types of music. Research suggests that the most
positive effects of music are found when the pa-
tient can choose the genre. Each of the five MP3
players was loaded with soft country, classical/
New Age, and inspirational music. Our team care-
fully reviewed all music for its appropriateness to
final total sample of 119 subjects. Additional com-
ments from subjects were collected along with
a brief chart review of demographic information
and pain medication used in the PACU. The entire
headsets and MP3 players were sanitized with Sani-
Cloth PLUS (Professional Disposables Interna-
tional, Inc., Two Nice-Pak Park Orangeburg, NY)
germicidal disposable cloths before and after use.
Results
The 119 women completing the study had a mean
age of 38.8 (standard deviation 5 2.2) years. There
were no significant differences in age or other
demographic characteristics by group (P ..05).
Table 2 provides general demographic information
for each of the three groups along with preopera-
tive medication use and type of procedure per-
formed.
To answer the research question, a repeated mea-
sure analysis of variance was performed using
Change in Anxiety
4.5

the setting. Any music that had extreme crescen- 4

Level of Reported Anxiety (0-10)

dos was eliminated. Headsets were chosen that 3.5

had padded ear covers. The MP3 player could be 3 Control (n=41)

set and locked keeping the volume at a constant 2.5 Music (n=43)
level. 2
Headphones only
1.5 (n=35)
Both music and headsets only were started in SDS 1
before preoperative medications. Both interven- 0.5
tions were continued throughout surgery and 0
Pre-op Anxiety Post -op Anxiety
removed when Aldrete LOC equals 2. Post-op anx-
iety was then rated. One subject in the music Figure 1. Changes in anxiety from pre-op to post-
group refused to complete the postanxiety score op for each group. All subjects included. This figure is
and was dropped from the analyses resulting in a available in color online at www.jopan.org.
152
Table 3. Comparison of All Subjects’ Anxiety Scores
All Subjects* Control (n 5 41)
Preoperative 3.98 (2.3)
Postoperative 2.15 (2.5)
Change in anxiety 21.83 (2.5)
*F 5 1.47 (degrees of freedom 1,2); P 5 .244.
PASW Statistics 17 (IBM Corp, Portsmouth, Hamp-
shire, UK). Figure 1 shows the change in anxiety
from pre-op to post-op for subjects by group. All
groups experienced a reduction in anxiety of
about 2 units, but there were no statistically sig-
nificant group differences (F 5 1.47 [2,116];
P 5 .224). Table 3 depicts the preoperative anxiety
and postoperative anxiety scores by group as well
as the change scores.
On closer examination, it was discovered that 12%
reported no anxiety pre-op and 51% had very low
levels of pre-op anxiety. Low anxiety (0-3) was
equally represented among the three groups. The
data were reanalyzed using only those with moder-
ate to high levels of pre-op anxiety ($4/10), and
these results are reported in Table 4. When exami-
ning those with moderate or high levels of pre-
operative anxiety, all groups experienced a drop
in anxiety from pre- to postoperative status, but
the control group had the smallest decrease
(F 5 3.5; P 5 .03; power 5 0.63). The music group
experienced the lowest postoperative anxiety
scores, but the headphone group had a slightly
greater overall change score because this group
had a slightly higher preoperative anxiety score
(Figure 2). This significance in anxiety reduc-
tion was similar to those studies previously re-
viewed4-6,8-13 where P values ranged from .05
to .002.
Many subjects offered comments and opinions re-
lated to the use of music or headphones. The only
negative comments were either from those who
Table 4. Comparison of Subjects With Preoperative Anxiety Scores $4*
Subjects With Preoperative
Anxiety $4* Control (n 5 17)
Preoperative 6.0 (1.5)
Postoperative 3.59 (3.1)
Change in anxiety 22.41 (3.6)
*F 5 3.41 (degrees of freedom 1,2); P 5 .04.
JOHNSON, RAYMOND, AND GOSS
Headphones (n 5 35) Music (n 5 43)
4.20 (2.7) 3.74 (2.4)
1.46 (1.8) 1.16 (2.2)
22.74 (2.6) 22.58 (2.5)
did not get music or related to the preferred type
of music available. The comments were similar to
those seen in the studies reviewed.4-6,8-13 See
Table 5 for examples of patient comments.
Although it was not a research question for this
study, post hoc we did examine the use of analge-
sics in the PACU. All narcotics were changed to the
equianalgesic dosing for opioids equivalents using
the 2007 Pharmacist’s Letter conversion table.15
The control group had a higher mean dose of anal-
gesics (4.01 mg) than either the headphones-only
group (3.6 mg) or the music group (2.92 mg). Al-
though the use of analgesic was 28% less in the mu-
sic group than in the control, it was not statistically
significant.
Discussion
Anxiety decreased after surgery; however, half
had low pre-op anxiety, making it difficult to see
the effect of music. This was surprising to us; how-
ever, as noted in the earlier study on anxiety, 35%
of women report feeling calm preoperatively.
Fifty-one percent of our participants had anxiety
ratings of 0 to 3. The fact that this unit is a new,
small, and women-only facility that focuses on
family-centered care may have had a calming effect
on the patients.
The team also considered the possibility of
measuring patient satisfaction. Patient satisfaction
was at the time just starting to be measured by
Press Ganey for outpatient procedures. Although
Headphones (n 5 15) Music (n 5 19)
6.13 (1.6) 6.05 (1.0)
1.93 (1.9) 1.71 (2.8)
24.80 (2.0) 24.08 (2.8)
PERIOPERATIVE MUSIC 153

Change in Anxiety Level for Those with Moderate to Table 5. Comments From Subjects
High Pre-op Anxiety
8
Usual care
Level of Reported Anxiety (0-10)

7
6
5
4
3 Headphones
2  Music is a great idea (two)
1
0
Pre-op Anxiety
Figure 2. Change in anxiety score over time in
those with moderate or high pre-op anxiety (4-10/
10). This figure is available in color online at www
.jopan.org.
our goal was to ultimately improve the overall ex-
perience of the patient, we did not feel patients
should receive another questionnaire to fill out at
that time. We felt a reduction in anxiety was
a needed outcome and measurable.
Pain reduction was considered initially as a purpose
of the study. However, to truly explore the effects of
music on pain, everything else would need to be
controlled. The surgeon, the amount of marcaine
used in the incisions, the type of surgery being pre-
formed, and the use of Toradol or other analgesics
preoperatively would all need to be controlled.
This did not appear to be feasible at our institution
at that time. In addition, the literature appeared to
have stronger support for anxiety reduction rather
than pain reduction (Table 1). The procedure of
starting the music in SDS and continuing it on into
the PACU is ideal. In our facility, we have continued
to offer music to preoperative patients in our
Women’s Center. A sign in the pre-op room tells
patients they may ask for MP3 players. In addition,
we have SDS nurses who have seen the benefits of
the music and are initiating it. Keeping track of
the players is a challenge, and each unit adopting
this intervention should have a procedure in place
to track the patients and equipment. We are noting
on the chart the patient has one of the players. SDS
nurses are giving a patient sticker to PACU nurses so
that the PACU nurse can be watching for the player.
After each use, the PACU staff sanitizes and re-
charges the players.
 Would have preferred music (three)
Control (n=17)  Brought own in past and found it beneficial to de-
Music (n=18)
crease anxiety
 ‘‘I was not really worried about the procedure; it was
only (n=15) just being in a hospital’’
Headsets only
Post -op Anxiety  Would have liked to have music (six)
 Headphones were annoying (seven)
 Helped to decrease anxiety pre-op (two)
Music
 ‘‘I loved it. I would highly recommend it. It was
wonderful to wake up to music’’
 ‘‘I love the music before but quiet after’’ (two)
 ‘‘It was calming, a good distraction. Helped me relax
pre-op’’
 ‘‘I think it helped keep me calm’’
 ‘‘I liked it’’ (eight)
 Would have liked music earlier when too many family
members were in the room
 ‘‘Best PACU experience ever had’’ Earlier experience
with postoperative nausea and vomiting none this
time
 ‘‘I would recommend this to anyone’’
 Would prefer music again if ever needed surgery
 Patient wanted it off in PACU because of waking up in
pain
 Would prefer jazz
 ‘‘The headphones were too big and kept falling off my
head—frustrating’’
 Reported anxiety level 7 in PACU because of pain and
urgency to urinate
PACU, postanesthesia care unit.
pre-op classes are also given the opportunity to
bring in their own players. We have recently pur-
chased enough players to place in each nurse
server in PACU. This way the players can be used
even if they have not received it before PACU.
Guided imagery for successful surgery has also
been added to our players since this study, at the
request of a patient.
Limitations

At this time, we are implementing this procedure All subjects were given music before pre-op medi-
in our main perioperative area. Patients attending cation; however, some had the opportunity to
154
listen longer than others preoperatively. We did
not collect data on this pre-op time. Subjects
gave their consent to participate in the study. If
a patient did not feel they would benefit from
the study, they chose not to participate. This nar-
rows the study group to only those who would
like music. It may not reflect the population at
large.
Conclusion
Music is a relatively inexpensive intervention, easy
to administer, noninvasive, and found to be a satis-
fier for most people. In addition, it offers patients
a coping strategy giving them a sense of control
over an unfamiliar environment and creating a pos-
itive patient outcome. Music can function as a dis-
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JOHNSON, RAYMOND, AND GOSS
tracter from the ambient noise of monitors, other
patients, staff, and equipment that routinely oc-
curs in the perioperative areas. The intentional
use of music can be instrumental in transforming
the environment of the surgical patient into
a soothing and restful atmosphere to decrease
anxiety and promote healing.
Acknowledgments
The authors acknowledge Linda S. Baas, PhD, RN, ACNP, Direc-
tor of Nursing Research, The Christ Hospital, for her assistance
with the design of the study and the statistical analysis of the re-
sults; Joyce Burke, RN, BES, CPAN, PACU, Clinical Manager, for
her support throughout the study; and PACU nurses Lisa Haub-
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