69 research outputs found
Adding value to care through live bedside music
Unfortunately, older patients are more prone to develop complications due to the ageing process. Nursing care, in which interventions are used to promote recovery, fulfils an important role in post-surgery care. Nonpharmacological Interventions are preferred in older patients because of the risk of side effects. Music is one such intervention. Centuries ago, music was used to promote well-being and even today, music often has a prominent role in daily life and at special moments. However, music is not yet a structural part of hospital care. Van der Wal-Huisman investigated how live music can be applied in hospital care, its effect on recovery and its perceived added value, with primary focus on the older surgical patient. In collaboration with professional musicians trained for this purpose at the Prince Claus Conservatoire, live music was played on the nursing ward, at the patient's bedside. Insights were gained into how music can contribute to recovery after surgery. Among others, patients experienced less pain, music seems to have a positive effect on the autonomic nervous system, which is involved in the recovery process after surgery, and it adds value to the emotional needs and experience of hospitalisation. Van der Wal- Huisman argues in her thesis for structural embedding of live music in healthcare because it fits in the ongoing transition in healthcare with increased attention for human values
Live bedside music in daily clinical practice of a surgical hospital ward among older patients:A controlled study design of an innovative practice
OBJECTIVE: There is an increasing interest in the role of the arts, particularly music, in healthcare. Music seems an attractive non-pharmacological intervention for older patients to improve postoperative outcomes. Although live music elicits more meaningful responses from an audience than recorded music, the use of live music is still rare on hospital wards. In view of the positive effects of recorded music on older surgical patients, we designed, in collaboration with a conservatoire, an innovative practice named Meaningful Music in Health Care (MiMiC). The aim is to determine whether live bedside music implements into daily practice and allows improves patient outcomes. METHOD: This manuscript provides an overview of a trial evaluating if live bedside music can improve postoperative outcomes in older patients. The MiMiC initiative is a non randomized controlled trial study among older surgical patients on three hospital wards. Live bedside music is performed by professional musicians, once a day for six or seven consecutive days. The primary outcome is experienced pain; secondary outcomes are anxiety, relaxation and physical parameters (heart rate, heart rate variability, blood pressure, respiratory rate and oxygenation). Measurements of these variables are collected before the intervention, 30 min afterwards and again after three hours. Daily evaluations determine whether this innovative practice can be implemented in daily practice. CONCLUSION: This manuscript describes a new practice, live bedside music by professional musicians, on surgical hospital wards aiming to improve patient outcomes. It offers a new field of interprofessional collaboration for the benefit of patients. Further research must be conducted focussing on patient outcomes, including cost-effectiveness and the experiences of patients and healthcare professionals
Live and Recorded Music Interventions to Reduce Postoperative Pain:Protocol for a Nonrandomized Controlled Trial
BACKGROUND: Postoperative patients who were previously engaged in the live musical intervention Meaningful Music in Healthcare reported significantly reduced perception of pain than patients without the intervention. This encouraging finding indicates a potential for postsurgical musical interventions to have a place in standard care as therapeutic pain relief. However, live music is logistically complex in hospital settings, and previous studies have reported the more cost-effective recorded music to serve as a similar pain-reducing function in postsurgical patients. Moreover, little is known about the potential underlying physiological mechanisms that may be responsible for the reduced pain perceived by patients after the live music intervention.OBJECTIVE: The primary objective is to see whether a live music intervention can significantly lower perceived postoperative pain compared to a recorded music intervention and do-nothing control. The secondary objective is to explore the neuroinflammatory underpinnings of postoperative pain and the potential role of a music intervention in mitigating neuroinflammation.METHODS: This intervention study will compare subjective postsurgical pain ratings among 3 groups: live music intervention, recorded music intervention, and standard care control. The design will take the form of an on-off nonrandomized controlled trial. Adult patients undergoing elective surgery will be invited to participate. The intervention is a daily music session of up to 30 minutes for a maximum of 5 days. The live music intervention group is visited by professional musicians once a day for 15 minutes and will be asked to interact. The recorded music active control intervention group receives 15 minutes of preselected music over headphones. The do-nothing group receives typical postsurgical care that does not include music.RESULTS: At study completion, we will have an empirical indication of whether live music or recorded music has a significant impact on postoperative perceived pain. We hypothesize that the live music intervention will have more impact than recorded music but that both will reduce the perceived pain more than care-as-usual. We will moreover have the preliminary evidence of the physiological underpinnings responsible for reducing the perceived pain during a music intervention, from which hypotheses for future research may be derived.CONCLUSIONS: Live music can provide relief from pain experienced by patients recovering from surgery; however, it is not known to what degree live music improves the patients' pain experience than the logistically simpler alternative of recorded music. Upon completion, this study will be able to statistically compare live versus recorded music. This study will moreover be able to provide insight into the neurophysiological mechanisms involved in reduced pain perception as a result of postoperative music listening.TRIAL REGISTRATION: The Netherlands Central Commission on Human Research NL76900.042.21; https://www.toetsingonline.nl/to/ccmo_search.nsf/fABRpop?readform&unids=F2CA4A88E6040A45C1258791001AEA44.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40034.</p
The Effect of Live Bedside Music on Pain in Elderly Surgical Patients. A Unique Collaboration
Postoperative pain has a negative influence on physical and mental recovery and may result in a variety of postoperative complications. Listening to recorded music has been revealed to reduce pain, but in addition to that, live bedside music further offers the possibility to interact with the patient, respond to their emotions, and help them in adapting their conditions. It, therefore, seems appropriate for older surgical patients. This study examines the effect of live bedside music on postoperative elderly patients. The study was designed as a prospective clinical pilot study with a control group. During six separate weeks, between September 2016 and May 2017, data were collected using convenience sampling among the postoperative patients aged β₯60 years (n = 35) accounting to 83 sessions. The intervention was live music, person-centred improvisation and existing repertoire, performed by professional musicians of a collaborating conservatoire for 10β15 min, one session a day on three surgical wards of a university hospital. The control group (n = 43; 80 sessions) did not receive the intervention. βThe primary endpoint was pain, measured with a visual analog scale (VAS; score 0-10) before the intervention and after 30 minutes and 3 hours of the session. Secondary endpoints were hemodynamic parameters, oxygen saturation, and respiratory rate and anxiety. The Wilcoxon signed-rank test and Mann-Whitney U test were performed to determine differences within and between groups. Perceived pain was decreased in the live bedside music group at the time of the first post-test and continued to be so for up to three hours (p = .004; p = .000). This decrease in pain was not observed in the control group. There was no clinically relevant effect on secondary endpoints. Live bedside music, performed by professional musicians, has a positive effect on the perceived pain of elderly patients after surgery. Further research on the underlying mechanisms as well as possible clinical implications is required
Strategies for involving family members in treatment decision making for older patients with cancer
Background and purpose: Many older patients with cancer have their family members, often their adult children, involved in a process of treatment decision making. Despite the growing awareness that family members can facilitate a process of shared decision making (SDM), literature about SDM pays little attention to family relations and strategies to facilitate family involvement in decision making processes. Therefor this study aimed to 1. explore surgeons' and nurses' perceptions about involvement of adult children in treatment decision-making for older patients; and 2. identify strategies surgeons' and nurses use to ensure positive family involvement. Methods: This study used a qualitative open in-depth interview design. Semi-structured interviews were conducted with 13 surgical oncologists and 13 oncology nurses in two hospitals in the Netherlands. Qualitative content analysis was conducted according to the steps of thematic analysis. Results: Surgeons and nurses indicated that adult children's involvement in decision-making increases when patients become frail. They reported beneficial and challenging characteristics of this involvement. Subsequently, six strategies to stimulate positive involvement of adult children in the decision-making process were revealed: 1. Focus on the patient; 2. Actively involve adult children; 3. Acknowledge different perspectives; 4. Get to know the family system; 5. Check that the patient and family members understand the information; and 6. Stimulate communication and deliberation with adult children.Conclusions and implications: Surgeons and nurses perceive involvement of adult children in treatment decision making for older patients with cancer as beneficial. Adult children can help these patients reach well-informed treatment decisions. Therefor surgeons and nurses stimulate the communication and deliberation between these patients and their adult children. However, involving family in treatment decision making also triggers specific complexities and challenges in treatment decision conversations that seem to call for the development and implementation of practical patient and family-centered strategies
Strategies for involving family members in treatment decision making for older patients with cancer
Background and purpose: Many older patients with cancer have their family members, often their adult children, involved in a process of treatment decision making. Despite the growing awareness that family members can facilitate a process of shared decision making (SDM), literature about SDM pays little attention to family relations and strategies to facilitate family involvement in decision making processes. Therefor this study aimed to 1. explore surgeons' and nurses' perceptions about involvement of adult children in treatment decision-making for older patients; and 2. identify strategies surgeons' and nurses use to ensure positive family involvement. Methods: This study used a qualitative open in-depth interview design. Semi-structured interviews were conducted with 13 surgical oncologists and 13 oncology nurses in two hospitals in the Netherlands. Qualitative content analysis was conducted according to the steps of thematic analysis. Results: Surgeons and nurses indicated that adult children's involvement in decision-making increases when patients become frail. They reported beneficial and challenging characteristics of this involvement. Subsequently, six strategies to stimulate positive involvement of adult children in the decision-making process were revealed: 1. Focus on the patient; 2. Actively involve adult children; 3. Acknowledge different perspectives; 4. Get to know the family system; 5. Check that the patient and family members understand the information; and 6. Stimulate communication and deliberation with adult children.Conclusions and implications: Surgeons and nurses perceive involvement of adult children in treatment decision making for older patients with cancer as beneficial. Adult children can help these patients reach well-informed treatment decisions. Therefor surgeons and nurses stimulate the communication and deliberation between these patients and their adult children. However, involving family in treatment decision making also triggers specific complexities and challenges in treatment decision conversations that seem to call for the development and implementation of practical patient and family-centered strategies
Does a participatory live music practice support nurses to deliver compassionate care to hospitalised patients?:A qualitative study
AIM: To gain more insight into how nurses experience a participatory live music practice in relation to their ability to deliver compassionate care to medically hospitalised patients.DESIGN: Qualitative interpretive design.METHODS: Sixteen nurses participating in a live music practice with patients were interviewed using in-depth interviews with open-ended questions. Audio recordings were transcribed verbatim and subsequently coded. Theory-driven inductive and deductive approaches were applied in thematic data analysis.RESULTS: We identified four themes: (1) Nurses' empathy and compassion; (2) The caring nurse-patient relationship; (3) Person-centred approaches to care and (4) Nurses' subjective wellbeing. By observing patients' reactions to the music, nurses described that they obtained a deeper insight and understanding of patients' emotional wellbeing. These observations led to increased feelings of compassion in patient contact and stimulated informal communication between nurses and patients through a sense of shared humanity. According to nurses, these aspects positively affected collaboration with patients in delivering care and stimulated them to pursue person-centred approaches to care. Participating in the live music practice also positively affected nurses' wellbeing, enhanced relaxation and created an ambiance in which compassion could be expressed.CONCLUSION: A live music practice can positively contribute to the delivery of compassionate care by providing meaningful shared moments that increase feelings of empathy and compassion and strengthen the caring relationship.IMPLICATIONS FOR THE PROFESSION: Offering a live music practice at the ward and bedside offers a unique possibility to enhance engagement in person-centred, compassionate care.IMPACT: While compassion and compassionate care are essential component of nursing, nurses often experience multiple barriers to its provision in daily practice. An innovative way to stimulate compassionate care is through the participation of nurses and patients in a live music practice, providing a meaningful moment shared between them. This stimulates feelings of shared humanity and bonding in the caring relationship.REPORTING METHOD: The COnsolidated criteria for REporting Qualitative research (COREQ). No Patient or Public Contribution.</p
Heart Rate Variability in Surgical Patients Experiencing Live Bedside Music:An Explorative Study
It's known that surgery elicits a stress response involving the autonomic nervous system (ANS) which is important in general recovery but can also have detrimental effects in older patients. Music seems to positively effect postoperative recovery, although the mechanism requires further unravelling. Our objective was to explore the response of the ANS to live bedside music in older surgical patients, by using heart rate variability (HRV) as a proxy. This explorative prospective non-randomized controlled cohort study included 101 older non-cardiac surgical patients, with a median age of 70 (range 60-88 years). HRV was measured in a cohort receiving live bedside music provided by professional musicians and in a control group that did not receive music. HRV was measured pre-intervention, during the intervention, 30 min after the intervention, and again after three hours. Mixed linear modelling was used to assess the effect of the intervention compared to the control group over time. A significant change in both the low and high frequency bands (pβ=β0.041) and (pβ=β0.041) respectively, was found over time in the music group compared to the control group indicating relaxation and increased parasympathetic activity in the music group. Other measures revealed a trend but no significant effect was shown. These results provide a first glance and contribute to a better understanding of the effect of music on the recovery of older surgical patients.</p
Does a participatory live music practice support nurses to deliver compassionate care to hospitalised patients?:A qualitative study
AIM: To gain more insight into how nurses experience a participatory live music practice in relation to their ability to deliver compassionate care to medically hospitalised patients.DESIGN: Qualitative interpretive design.METHODS: Sixteen nurses participating in a live music practice with patients were interviewed using in-depth interviews with open-ended questions. Audio recordings were transcribed verbatim and subsequently coded. Theory-driven inductive and deductive approaches were applied in thematic data analysis.RESULTS: We identified four themes: (1) Nurses' empathy and compassion; (2) The caring nurse-patient relationship; (3) Person-centred approaches to care and (4) Nurses' subjective wellbeing. By observing patients' reactions to the music, nurses described that they obtained a deeper insight and understanding of patients' emotional wellbeing. These observations led to increased feelings of compassion in patient contact and stimulated informal communication between nurses and patients through a sense of shared humanity. According to nurses, these aspects positively affected collaboration with patients in delivering care and stimulated them to pursue person-centred approaches to care. Participating in the live music practice also positively affected nurses' wellbeing, enhanced relaxation and created an ambiance in which compassion could be expressed.CONCLUSION: A live music practice can positively contribute to the delivery of compassionate care by providing meaningful shared moments that increase feelings of empathy and compassion and strengthen the caring relationship.IMPLICATIONS FOR THE PROFESSION: Offering a live music practice at the ward and bedside offers a unique possibility to enhance engagement in person-centred, compassionate care.IMPACT: While compassion and compassionate care are essential component of nursing, nurses often experience multiple barriers to its provision in daily practice. An innovative way to stimulate compassionate care is through the participation of nurses and patients in a live music practice, providing a meaningful moment shared between them. This stimulates feelings of shared humanity and bonding in the caring relationship.REPORTING METHOD: The COnsolidated criteria for REporting Qualitative research (COREQ). No Patient or Public Contribution.</p
Association between anaesthesia-related factors and postoperative neurocognitive disorder:a post-hoc analysis
BACKGROUND: Postoperative neurocognitive disorder (pNCD) is common after surgery. Exposure to anaesthetic drugs has been implicated as a potential cause of pNCD. Although several studies have investigated risk factors for the development of cognitive impairment in the early postoperative phase, risk factors for pNCD at 3 months have been less well studied. The aim of this study was to identify potential anaesthesia-related risk factors for pNCD at 3 months after surgery.METHODS: We analysed data obtained for a prospective observational study in patients agedββ₯β65 years who underwent surgery for excision of a solid tumour. Cognitive function was assessed preoperatively and at 3 months postoperatively using 5 neuropsychological tests. Postoperative NCD was defined as a postoperative decline of β₯β25% relative to baseline in β₯β2 tests. The association between anaesthesia-related factors (type of anaesthesia, duration of anaesthesia, agents used for induction and maintenance of anaesthesia and analgesia, the use of additional vasoactive medication, depth of anaesthesia [bispectral index] and mean arterial pressure) and pNCD was analysed using logistic regression analyses. Furthermore, the relation between anaesthesia-related factors and change in cognitive test scores expressed as a continuous variable was analysed using a z-score.RESULTS: Of the 196 included patients, 23 (12%) fulfilled the criteria for pNCD at 3 months postoperatively. A low preoperative score on Mini-Mental State Examination (OR, 8.9 [95% CI, (2.8-27.9)], pβ<β0.001) and a longer duration of anaesthesia (OR, 1.003 [95% CI, (1.001-1.005)], pβ=β0.013) were identified as risk factors for pNCD. On average, patients scored higher on postoperative tests (mean z-score 2.35[Β±β3.13]).CONCLUSION: In this cohort, duration of anaesthesia, which is probably an expression of the complexity of the surgery, was the only anaesthesia-related predictor of pNCD. On average, patients' scores on cognitive tests improved postoperatively.</p
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