KRISHNA INSTITUTE OF MEDICAL SCIENCES

DEEMEDTO BE UNIVERSITY, KARAD

KRISHNA INSTITUTE OF NURSING SCIENCE, KARAD

“EFFECTIVENESS OF MUSIC INTERVENTION ON DEPRESSION, ANXIETY,

STRESS AND PAIN AMONG PATIENTS ADMITTED IN CRITICAL CARE
UNIT”

1
 DISSERTATION
SUBMITTED TO THE KRISHNA INSTITUTE OF MEDICAL SCIENCES
DEEMED TO BE UNIVERSITY KARAD MAHARASTRA
IN THE PARTIAL FULFILLMENT OF REQUIREMENT FOR THE
COMPLETION OF BACHELORETTE DEGREE IN NURSING

BY
MISS. BETSY SARA BIJU
MR. PRATHMESH BORAGE
MISS. ANUSHKA CHAULKAR
MR. PRATHAMESH DHARME

4th yr. BSc NURSING STUDENT

UNDER THE GUIDANCE OF
MR. AJIT PAWAR
CLINICAL INSTRUCTOR
KRISHNA INSTITUTE OF NURSING SCIENCE KARAD

2
 KRISHNA INSTITUE OF MEDICAL SCIENCES DEEMED
TO BE UNIVERSITY KARAD

KRISHNA INSTITUTE OF NURSING SCIENCES, KARDA,

MAHARASTRA

CERTIFICATE BY THE GUIDE

This is certified that the project work entitled, “EFFECTIVENESS OF MUSIC

INTERVENTION ON DEPRESSION, ANXIETY, STRESS AND PAIN AMONG
PATIENTS ADMITTED IN CRITICAL CARE UNIT”. Is Bonafede and genuine
research work done by urban area karad.

PROJECT GUIDE :

DATE

Place Mr. Ajit Pawar

Clinical instructor

KINS, Karad

3
KRISHNA INSTITUE OF MEDICAL SCIENCES DEEMED
TO BE UNIVERSITY KARAD

KRISHNA INSTITUTE OF NURSING SCIENCES, KARDA,

MAHARASTRA

DECLARATION BY THE CANDIDATE

We hereby declare that the project work entitled “EFFECTIVENESS OF MUSIC

INTERVENTION ON DEPRESSION, ANXIETY, STRESS AND PAIN
AMONG PATIENTS ADMITTED IN CRITICAL CARE UNIT” is bonafide
and genuine research work carried out under the guidance of Mr. Ajit Pawar
Clinical Instructor, KINS Karad.

Group Members

MISS. BETSY SARA BIJU

MR. PRATHMESH BORAGE

MISS. ANUSHKA CHAULKAR

MR. PRATHAMESH DHARME

4
 KRISHNA INSTITUE OF MEDICAL SCIENCES DEEMED
TO BE UNIVERSITY KARAD

KRISHNA INSTITUTE OF NURSING SCIENCES, KARDA,

MAHARASTRA

ENDORSEMENT BY THE PRINCIPAL

This is to certify that the project work entitled “EFFECTIVENESS OF MUSIC INTERVENTION
ON DEPRESSION, ANXIETY, STRESS AND PAIN AMONG PATIENTS ADMITTED IN
CRITICAL CARE UNIT” is bonafide and genuine research work done by Miss. Betsy Sara Biju, Mr.
Prathmesh P Borage, Miss. Anushka Chaulkar, Mr. Prathamesh S Dharme under the guidance of Mr.
Ajit Pawar Clinical Instructor KINS Karad.

Signature and Seal

Dr. Prof. Mrs. Vaishali R Mohite

Dean and Principal

KINS Karad

Date:

Place

5
 ACKNOWLEDGEMENT
We Betsy Sara Biju, Prathmesh P Borage, Anushka Chaulkar,Prathamesh S Dharmeof 4th
Year BSc. Nursing of Krishna Instituteof Nursing Science Karad would like to express my special
thanks to the God the Almighty for his showers of blessings throughout my research work to complete
the research successfully.

I would like to express my gratitude to our class coordinatorDr. Shivaji Pawar Associate
Professor, KINS Karad, has given me the opportunity to conduct this study.

I would like to express my deep and sincere gratitude to my research guideMr. Ajit Pawar
Clinical Instructor KINS Karad for providing invaluable guidance and support throughout this
research. It was a grate privilege and honor to work and study under his guidance. I am extremely
grateful for his support and encouragement. He was there throughout my entire study.

I extend my heartfelt thanks toDr. Mrs. Vaishali R Mohite Dean and Principal, KINS Karad
for her expert comments and guidance until the completion of this project.

I am sincerely thankful to Mrs. Lakshmi Nayar Clinical instructor KINS Karad for her co-
operation and guidance throughout this study.

I am extremely grateful to my parent’s father, mother, sister and close relatives for their
unconditional love, constant support and encouragement throughout the hard time.

I thankfully acknowledge everyone responsible directly and indirectly in the completion of this
study.

My heartful thanks to all

Miss Betsy Sara Biju

Mr. Prathmesh P Borage

Miss. Anushka Chaulkar

Mr. Prathamesh S Dharme

6
4th year BSc Nursing students

ABSTRACT
Music therapy is the use of music to address the physical, emotional, cognitive, and social needs
of a group or individual. It employs a variety of activities, such as listening to melodies, playing an
instrument, drumming, writing songs, and guided imagery. . Music therapy is appropriate for people of
all ages, whether they are virtuosos or tone deaf, struggling with illness or totally healthy. Music therapy
sessions are design with a number of factors in mind, including the client’s physical health
communication ability, cognitive skills, emotional wellbeing and interests. After weighing this factor
along with treatment goals, the therapist decides to employ either the creative or receptive process.

STATEMENT OF THE PROBLEM:

“Effectivness of music intervention on depression, anxiety, stress and pain among patient admitted in
critical care unit”.

AIM:

To explore use of music therapy in reducing level of depression, anxiety, stress and pain among patient
admitted in critical care unit (ICU)

OBJECTIVE OF THE STUDY:

a) Assess level of depression among critically ill patients admitted in

critical care unit.
b) Assess level of anxiety among patients admitted in critical care unit.
c) Assess level of Stress among patients admitted in critical care unit.
d) Assess level of pain among critically ill patients admitted in critical care unit.
e) Assess music interventions on depression among patients admitted in critical care unit.
f) Assess music intervention on anxiety among patients admitted in ICU.
g) Assess music interventions on stress admitted in critical care unit.
h) Assess music interventions on the patients admitted in critical care unit.
i) To find out association between depression and socio-demographic variables
j) To find out association between anxiety and socio-demographic variables
k) To find out association between stress and socio-demographic variables.

7
 l) To find out association between Pain and socio-demographic variables.

METHODS:

Non-experimental description design was used to assess the knowledge and attitudes towards among
patients admitted in critical care unit. The study was conducted at urban area of karad taluka, Krishna
Hospital. 50 members participated in the study. simple random sampling technique was used to select
the sample. The collected data was analysed using both descriptive and inferential statistics.

RESULT:

Music therapy can help to decrease our anxiety, stress, depression and pain. In our study before giving
the music therapy the patients was having anxiety related to the hospital stay, stress related to family
etc…after analysis with them through communication we provided them music therapy. After that we
again communicate with then and ask them what they feel. They said that they fell little free form all
emotional factors (stress, anxiety, depression etc…)

CONCLUSION:

From our research study we come to know that music therapy can help to decrease our anxiety, stress,
depression and pain. In our study we giving the music therapy to critical patients who is having anxiety,
depression, stress and pain. By giving music therapy this all factors will reduce to some extend. We
inform them to listen to music so that they can get a big relief from all level of emotional factors (stress,
anxiety, depression etc..)

KEY WORDS:

Effectiveness, Anxiety, Pain, Depression, Stress

8
 TABLE OF CONTENT
CHAPTER NO. PARTICIPANT PAGE N0.
1  INTRODUCTION
 NEED FOR STUDY
 STATEMENT PROBLEM
 OPERATIONAL DEFINATION
2.  REVIEW OF LITRATURE
3.  RESEARCH METHODOLGY
 RESEARCH APPROACH
 RESEARCH DESIGN
 RESEARCH SETTING
 VARIABLE
 POLLULATION
 SAMPLE
 SAMPLING TECHNIQUE
 SAMPLE SIZE
 CRITERIA FOR DATA COLLECTION
 DATA COLLECTION PROCEDURE
 DATA ANLYSIS
 DESCRIPTION OF TOOLS
 SUMMARY
4.  ANALYSIS AND INTERPRITAION OF DATA
 SECTION 1
 SECTION 2
 SECTION 3
 SECTION 4
 SECTION 5
 SECTION 6
 SECTION 7
5.  DISCUSSION AND SUMMARY
 DISSCUSSION
 MAJOR FINDINGS
 CONCLUSIN
 IMPLICATION OF STUDY
 IMPLICATION OF NURSING EDUCATION
 NURSING PRACTICE
 RECOMMENDATION
 LIMITATION OF STUDY
 SUMMARY
6.  REFERANCE
7.  RESEARCH TOOLS.

9
 LIST OF TABLE

Sr. No Particulars Page No

1 Section 1: Frequency and Percentage distribution
of demographic variables of participants.

2 Section 2: Assess level of depression, anxiety,

stress and pain among critically ill patients
admitted in Critical Care Unit.
Sr. No Particulars Page No
1 Schematic representation of research design.

3 Section 3: Assess music interventions on

2 Figure 1: Distribution of samples according to their age.
depression, anxiety, stress and pain among

3 patients admitted inofcritical

Figure 2: Distribution samplescare unit. to their
according
gender.

4 Section 4:To find out association between

4 Figure 3: Distribution of samples according to their
education and socio-demographic variables.
depression

5 Figure 4: Distribution of samples according to their

5 Section 5: To find out association between
marital status
anxiety and socio-demographic variables

66 Figure 5: Distribution of samples according to their

Section 6: To find out association between stress
Occupation.
and socio-demographic variables.
7 Figure 6: Distribution of samples according to their
residence.
7 Section 7: To find out association between Pain
and socio-demographic variables

CHAPTER 1
10
INTRODUCTION

11
 CHAPTER 1

INTRODUCTION
“HEALTH IS THE GREATEST OF HUMAN BLESSING”

-HIPPOCRATES

Music therapy is the use of music to address the physical, emotional, cognitive, and social needs
of a group or individual. It employs a variety of activities, such as listening to melodies, playing an
instrument, drumming, writing songs, and guided imagery.

Music therapy is the use of music to address the physical, emotional, cognitive, and social needs
of a group of individual.it employs variety of activity, such as listening to melodies, playing and
instruments, drumming, writing songs and guided imagery. Music therapy is appropriate for people of
all ages, whether they are virtuosos or tone deaf, struggling with illness or totally healthy. Music therapy
sessions are design with a number of factors in mind, including the client’s physical health
communication ability, cognitive skills, emotional wellbeing and interests. After weighing this factor
along with treatment goals, the therapist decides to employ either the creative or receptive process.

Music therapy is an allied health profession, delivering health services that are outside the scope
of those traditionally provided by physicians and nurses. Because music is a familiar and powerful
medium, it is conducive to application across the lifespan, from use in neonatal intensive care units to
nursing homes and hospice facilities. Psychiatric hospitals, correctional institutions, and drug
rehabilitation centers may also use music therapy. Trained and certified music therapists work in a
variety of healthcare and educational settings. They often work with people suffering from emotional
health issues such as grief, anxiety, and depression. They also help people address rehabilitative needs
after a stroke, a traumatic head injury, or with chronic conditions like Parkinson’s or Alzheimer’s
disease.

There are two main types of depression, major depression (or major depressive disorder) and
dysthymic disorder. A person diagnosed with Major Depression has experienced the previously
mentioned symptoms for longer than 2 weeks. These symptoms either can occur repeatedly (called
episodic) or only once; but they are typically severe. A Dysthymia diagnosis means that depressive
symptoms are less severe, and they have been present for at least 2 years on more days than not.

12
Individuals with bipolar disorder also display symptoms of depression. Bipolar disorder is a severe
illness in which moods swing between ‘up’ states and ‘down’ states. Bipolar ‘up’ states, called mania,
are characterized by a euphoric (joyful, energetic) mood, hyper-activity, a positive, expansive outlook

on life, grandiosity (a hyper-inflated sense of self-esteem), and a sense that anything is possible. A
person in the ‘down’ state of bipolar disorder experiences one or more of the depressive symptoms
mentioned previously.

Natural Therapies for Depression

These complimentary medicines have been well- · St John’s Wort
studied for both effectiveness and safety issues and · Exercise
A
can be recommended on the basis of their scientific
and traditional-use background.
These complimentary medicines have at least some · Omega-3 Fatty Acids
clinical studies in humans to support their use along · SAM-E
B with a long history of traditional use. They can be · 5-HTP
recommended for use on the basis of their traditional
use and their relative safety.
These complimentary medicines lack the support of · Acupuncture
good clinical studies in humans, but have been used · B-Vitamins
traditionally, or have some studies that suggest that · Homeopathy
C
they might be effective. They can be recommended · Yoga
for use with the caution that they are not well-
supported by research.
These are complimentary medicines that cannot be
recommended for use because are harmful, not
D
effective, or are too new to make a judgment about
their safety or effectiveness.

Anxiety disorder may make you feel anxious most of the time, without any apparent reason. Or the
anxious feelings may be so uncomfortable that to avoid them you may stop some everyday activities. Or
you may have occasional bouts of anxiety so intense they terrify and immobilize you.

Anxiety disorders are the most common of all the mental health disorders. Considered in the category of
anxiety disorders are: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Phobia,
Obsessive Compulsive Disorder, Specific Phobia, Post-Traumatic Stress Disorder, and Acute Stress
Disorder. Anxiety disorders as a whole cost the United States between 42-46 billion dollars a year in
direct and indirect healthcare costs, which is a third of the yearly total mental health bill of 148 billion
dollars. In the United States, social phobia is the most common anxiety disorder with approximately 5.3
13
million people per year suffering from it. Approximately 5.2 million people per year suffer from post-
traumatic stress disorder. Estimates for panic disorder range between 3 to 6 million people per year, an
anxiety disorder that twice as many women suffer from as men. Specific phobias affect more than 1 out
of every 10 people with the prevalence for women being slightly higher than for men. Obsessive
Compulsive disorder affects about every 2 to 3 people out of 100, with women and men being affected
equally.

Stress is experienced when a body responds to any kind of excessive demand; stress can be caused
by both good and bad experiences. When a body feels stressed by something around, it reacts by
releasing chemicals into the blood, which gives the body more energy and strength. This can be a good

thing, if the stress is caused by physical activity. Similarly, it can be a bad thing when stress is in
response to an emotional instance and there is no outlet for this extra energy and strength. In this blog
we will be discussing about – the different causes of stress, how it affects you, the difference between
‘good’ or ‘positive’ stress and ‘bad’ or ‘negative’ stress, and some common facts about how stress
affects people today.

Positive stress

Positive stress can inspire people to do their best and perform better than if they were under no pressure.
Positive stress has the following characteristics:

Motivates, focuses energy

Positive stress is a coping ability

Provides excitement

Improves performance – both physical and psychological

Negative stress

Negative stress is the opposite of Positive stress. The characteristics are as follows:

Negative stress causes anxiety

Feels unpleasant

Decreases endurance and/or performance

May lead to both physical and psychological problems

What causes stress?

14
There’s no particular fixed cause for stress; the reasons can be personal, social or even work related for
that matter. Depression, guilt, physique, relationship issues, death or major life instances, financial
problems, traumatic events can be included as agents of stress.

Long term stress and its consequences

Long term stress takes its toll on the functioning and condition of both human body and mind. Please
find below some of the consequences of long-term stress.

Depression, anxiety and personal disorders. Panic attacks are the most extreme reactions from stress.

Hypertension, heart failure, heart attacks, cardiac arrhythmia, atherosclerosis are few cardiovascular
diseases that can result from stress.

Obesity, anorexia and bulimia are some of the psychological effects that take a toll on the physical
condition of a body.

Sexual dysfunction, low fertility is also a result of chronic stress.

Acne, permanent hair loss, eczema, gastro-intestinal diseases, lung diseases which have a direct impact
on the immune system may be a result of chronic stress.

Reducing/avoiding stress

Although stress cannot be controlled, it can be managed with the following techniques.

Maintaining a positive attitude throughout is the most basic need to avoid/ deal with stress.

Communication has to be done in a positive, thoughtful manner. Any kind of negative emotion can lead
to excessive stress.

Anger management is a key component to reduce/control stress

Stressful situations are best when avoided; time management also helps you to complete your work on
time and avoid stress.

Involve yourself by participating in de-stressing activities like gardening, reading, etc.

Self-reflection for 15-20 minutes every day can help you to neglect negative thoughts from affecting
your thinking.

Yoga and meditation are also very useful to relax your muscles and avoid stress.

15
Pain is the most common symptom of disease, which accompanies us from an early age. It is a
protective mechanism to which the body responds to harmful stimulus. The definition of pain states that
it is a subjective sensory and emotional experience. It is connected to the stimulus that it invokes and is
also based on the observation of psychological interpretation of the phenomena taking place. Pain is
individual for each person. Pain affects both our previous experience of pain and psychosomatic
conditions, depending on the relationship between the psyche and the body. Pain is always an
unpleasant sensation. The feeling of pain can be caused by irritation of pain receptors, which can be
found in the skin, joints and many internal organs. The cause of pain may also be damage to the nervous
system, both the peripheral nerves, brain and spinal cord. Pain can also occur without damage to tissues,
although the patient refers to it (psychogenic pain). The process of pain is a complex phenomenon.
Experience of pain depends on the strength of the stimulus, individual susceptibility and individual
resistance to pain. Pain receptors are sensitive to mechanical, thermal or chemical stimuli. The operation
of noxious stimulus to these receptors results in the processing into an electrical signal. This impulse is
conducted by nerve fibres into the spinal cord and then to the brain. At this point, there is the realization

that something hurts us. Pain is not only somatic in nature, associated with the condition of the body, but
it is a multidimensional phenomenon. Therefore, in addition to the physiological process of pain, its
subjective perception is also important, which is decided by the central nervous system. It consists of the
emotional aspects: suffering and attitude towards pain and pain expression. A review of pain physiology
is essential to fully understand the principles of pain management.

Clinical features include: location, intensity, duration and quality. these qualities are evaluated mainly
subjectively. the location of pain allows determination of the possible cause. the location of a pain does
not always correspond to the site of injury or disease process. Deep organ pains are particularly poorly
located. this is clinically important asit can hinder the location of the disease. Pain often occurs
as a phenomenon rejected pain (projected). Phenomenon of projection stems from the fact that the
internal organs do not have pain receptors, one the overlying protonium has extensive sensory
innervations. the intensity of pain
experienced by the patient is individual and is the most difficult feature to assess. the exponent of the
intensity of pain is its tolerance. Women have the highest tolerance, men and children the least

16
 NEED FOR THE STUDY

“THE ONLY SOURCE OF KNOWLDGE IS EXPERIENCE”

-ALBERT EINSTEIN

A depression is common and serious medical illness. It is feeling of sadness that causes long
period of unhappiness, medical tiredness, loss of appetite and sleeping problem are symptoms of
depression abuse past physical, sexual or emotional abuse can increase the vulnerability to clinical
depression later in life. Music intervention seems to reduce depressive symptoms and helps to improve
functioning eg. maintaining involvement in jobs, activities in relationship. Stress is the body's reaction
to any change that requires an adjustment or response. Anxiety is a feeling of worry, nervousness about
something with an uncertain outcome. Music affects the amount of stress hormones , such as adrenaline
and corticosol , that the body releases and reducing this hormones can help relieve symptoms of
anxiety.
Firstly we doing this study of the music intervention on the pain ,stress , anxiety and depression
among patients who are admitted in critical care unit. The patient are admitted in the CCU these
unaware about the environment of ICU and they get restlessness and some anxiousness which will may
leads to anxiety and depression. To reduce this in some extent the music interventions will be
implemented for these patients. In these intervention, we are not using any type of medications & drug
we provide headset to the patient and tell them to listen to music. And most important, these music
interventions are not harmful to any patient, in critical care. This is only for their mind relaxation mind
relaxation.Musical intervention may be effective to reduce depression, stress, anxiety and pain so
application at community level of music therapy will reduce prevalence

STATEMENT OF THE PROBLEM:

EFFECTIVNESS OF MUSIC INTERVENTION ON DEPRESSION, ANXIETY, STRESS

AND PAIN AMONG PATIENT ADMITTED IN CRITICAL CARE UNITE.

AIM:

To explore use of music therapy in reducing level of depression, anxiety, stress and pain among patient
admitted in critical care unit (ICU)
17
OBJECTIVE OF THE STUDY:

a) Assess level of depression among critically ill patients admitted inCriticalCare Unit.
b) Assess level of anxiety among patients admitted in critical care unit.
c) Assess level of Stress among patients admitted in critical care unit.
d) Assess level of pain among critically ill patients admitted in critical care unit.
e) Assess music interventions on depression among patients admitted in critical care unit.
f) Assess music intervention on anxiety among patients admitted in ICU.
g) Assess music interventions on stress admitted in critical care unit.
h) Assess music interventions on the patients admitted in critical care unit.
i) To find out association between depression and socio-demographic variables
j) To find out association between anxiety and socio-demographic variables
k) To find out association between stress and socio-demographic variables.
l) To find out association between Pain and socio-demographic variables

HYPOTHESIS:

H0: There is relation between the pretest and posttest variable.

H1: There is an association between sociodemographic data and knowledge score

OPERATIONAL DEFINITIONS:

Effectiveness: It is the capability of producing a desired result or the ability to produce desired output.

Stress:Stress is the body's reaction to any change that requires an adjustment or response.

Anxiety:Anxiety is a feeling of worry, nervousness about something with an uncertain outcome.

Depression: It is feeling of sadness that causes long period of unhappiness, medical tiredness, loss of
appetite and sleeping problem are symptoms of depression abuse past physical, sexual or emotional
abuse can increase the vulnerability to clinical depression later in life.

Pain:It is a protective mechanism to which the body responds to harmful stimulus

SUMMARY:

18
This chapter deals with the introduction, need for study, problem statement, objectives, assumption,
hypothesis, conceptional framework and operational definitions of the study.

19
REVIEW OF LITRATURE

CHAPTER 2
20
 REVIEW OF LITERATURE

A review of literature is an essential aspect of scientific research. It is a written summary of the

state of exiting knowledge on a research problem. It entails the systematic identification, reflection,
critical thinking and reporting of existing information in relation to the problems of interest. The
purpose of review of literature is to obtain comprehensive knowledge and in-depth information about
effectiveness of structured teaching program on smart digital watch.

A literature is a summary of previous research on a topic which can be either part of a research
project, a thesis or a bibliographic essay that is published separately in a scholarly journal. The
investigator carried out extensive review of literature on selected topics both research and non-research
in order to gain maximum relevant information and to perform in a scientific manner.

This Research is conducted by Daniel leubunner and this Hinderberg (2o17) Depression is a very
common mood disorder resulting in loss of social function of reduce quality of life and increased
mortality. "music intervention have been shown to be a potential and alternative for depression therapy
randomized controlled study design where preferred 28 studies with a total number of 1810 participants
were selected. In this research, they examined whether and to what extend music intervention could
significantly affect the emotional need of people living with depression.

Effect of music intervention on anxiety in ventilation -dependent patient. This research is conducted by
HLC Wong, vioceta Lopez -nehas, a Molassiotis in (2001) on the purpose of this study was to assess the
effectiveness of music intervention in decreasing anxiety in ventilator dependent patient. The intensive
care unit of the University hospital in Hong Kong was used as the setting for this study. Twenty patients
who were recruited for the study.

This reserch is conducted by martina de Write in(2020).music intervention are used for Stress
reduction in variety of setting because if the positive effectiveness of music listening on Both
physiological arousal and psychological stress experiences results show that music Intervention Had a
overall significant effect on stress reducing we conducted a computer based research of the
psychological and mental electronic literature data base.

Effects of music therapy on depression: A meta-analysis of randomized controlled trials

conducted by Qishou Tang, Zhaohui Huang, Huan Zhou and Peijie Ye (2020) they aimed to determine
and compare the effects of music therapy and music medicine on depression, and explore the potential
factors associated with the effect. A total of 55 RCTs were included in our meta-analysis. Music therapy
21
exhibited a significant reduction in depressive symptom (SMD = −0.66; 95% CI = -0.86 to -
0.46; P<0.001) compared with the control group; while, music medicine exhibited a stronger effect in
reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P<0.001). Music therapy and
music medicine both exhibited a stronger effects of short and medium length compared with long
intervention periods. A different effect of music therapy and music medicine on depression was
observed in our present meta-analysis, and the effect might be affected by the therapy process.

Effects of music therapy on anxiety: A meta-analysis of randomized controlled trial (2021) This study
aims to evaluate the efficacy of music therapy on anxiety from randomized controlled trials
(RCTs). Thirty-two studies with 1,924 participants were included in the meta-analysis. Music therapy
lasted an average of 7.5 sessions (range, 1-24 sessions), while the average follow-up duration was 7.75
weeks (range, 1-16 weeks). Music therapy significantly reduced anxiety compared to the control group
at post-intervention (SMD = -0.36, 95% CI: -0.54 to -0.17, p < 0.05), but not at follow-up (SMD = -
0.23, 95% CI: -0.53 to 0.08, p >0.05). Subgroup analysis found a significantly positive effect of music
therapy on anxiety in < 60 and ≥ 60 age-group (SMD = -0.31, 95% CI: -0.52 to -0.09, p < 0.05; SMD = -
0.45, 95% CI: -0.85 to -0. 05, p < 0.05), developed and developing country group (SMD = -0.28, 95%
CI: -0.51 to -0.06, p < 0.05; SMD = -0.49, 95% CI: -0.80 to -0.17, p < 0.05), < 12 and ≥ 12 sessions
group (SMD = -0.24, 95% CI: = -0.44 to -0.03, p < 0.05; SMD = -0.59, 95% CI: -0.95 to -0.22, p <
0.05), respectively. Our study indicated that music therapy can significantly improve anxiety during
treatment. But given that only eight RCTs reported the effects of music therapy at follow-up and the
duration of follow-up was inconsistent, further researches are needed on the lasting effects after the
intervention is discontinued.

Music therapy for stress reduction: a systematic review and meta-analysis (2020) Music therapy is
increasingly being used as an intervention for stress reduction in both medical and mental healthcare
settings. To summarize the growing body of empirical research on music therapy, a multilevel meta-
analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the
strength of the effects of music therapy on both physiological and psychological stress-related outcomes,
and to test potential moderators of the intervention effects. Results showed that music therapy showed
an overall medium-to-large effect on stress-related outcomes (d = .723, [.51–. Larger effects were found
for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list controls
instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted in Non-
Western countries compared to Western countries. Implications for both music therapy and future
research are discussed.

22
Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimer’s Type Dementia:
Randomised, Controlled Study Guétin S., · Portet F., Picot M.C.· PommiéC.· Messaoudi M. · Djabelkir
L. · Olsen A.L. · Cano M.M.· Lecourt E.· Touchon J. The aim of this controlled, randomised study was
to assess the effects of this new music therapy technique on anxiety and depression in patients with mild
to moderate Alzheimer-type dementia. Methods: This was a single-centre, comparative, controlled,
randomised study, with blinded assessment of its results. The duration of follow-up was 24 weeks. The
treated group (n = 15) participated in weekly sessions of individual, receptive music therapy. The
musical style of the session was chosen by the patient. The validated ‘U’ technique was employed. The
control group (n = 15) participated under the same conditions in reading sessions. The principal
endpoint, measured at weeks 1, 4, 8, 16 and 24, was the level of anxiety (Hamilton Scale). Changes in
the depression score (Geriatric Depression Scale) were also analyzed as a secondary
endpoint. Results: Significant improvements in anxiety (p < 0.01) and depression (p < 0.01) were
observed in the music therapy group as from week 4 and until week 16. The effect of music therapy was
sustained for up to 8 weeks after the discontinuation of sessions between weeks 16 and 24 (p < 0.01).
These results confirm the valuable effect of music therapy on anxiety and depression in patients with
mild to moderate Alzheimer’s disease. This new music therapy technique is simple to implement and
can easily be integrated in a multidisciplinary programme for the management of Alzheimer’s disease.

Does music therapy improves anxiety and depression in Alzheimer’s patients (2018), A sample
of 25 patients with mild Alzheimer's received therapy based on the application of a music therapy
session lasting 60 min. Before and after the therapy, patient saliva was collected to quantify the level of
salivary cortisol using the Enzyme-Linked ImmunoSorbent Assay (ELISA) immunoassay technique and
a questionnaire was completed to measure anxiety and depression (Hospital Anxiety and Depression
Scale). The results show that the application of this therapy lowers the level of stress and decreases
significantly depression and anxiety, establishing a linear correlation between the variation of these
variables and the variation of cortisol.

Effects of music therapy on anxiety, depression and self-esteem of undergraduates conducted by Shwu
Ming WU (2022), The purpose of this study was to examine the effects of music therapy on anxiety,
depression and self-esteem of undergraduates. Twenty-four I-Shou University undergraduates who
showed greater anxiety and depression with lower self-esteem were randomly assigned to experimental
and control groups. The experimental group was provided 20 hours of music therapy, whereas the
23
control group did not receive any treatment. Both quantitative and qualitative analyses were utilized to
evaluate the changes of the participants. The findings indicated that the experimental group
demonstrated a reduction in anxiety immediately after the music therapy and after a two-month follow-
up, but only reduced depression after the follow-up. Moreover, the experimental group expressed that
they experienced more positive changes, including more pleasure, relaxation, and confidence, and fewer
negative emotions.

Effect of Music Therapy on Pain After Orthopedic Surgery—A Systematic Review and Meta-
Analysis (2019), This systematic review aimed to examine the effects of music therapy on pain after
orthopedic surgery. Nine randomized controlled trials were selected. Music can relieve pain
significantly for both music medicine and music therapy. Music chosen by the subjects showed
significant differences for both MM (P = 0.002) and MT (P = 0.02). Anxiety improved significantly
among patients using MT. However, the results for the physiologic parameters, opioid requirement, and
length of stay showed subtle distinctions. Music can significantly relieve POP, specifically music
chosen by the participants.

The effectiveness of music therapy for patients with cancer: A systematic review and meta-
analysis (2020), assess the effectiveness of music therapy on the quality of life, anxiety, depression and
pain of patients with cancer. A total of 19 trials evaluating 1,548 patients were included in this study, of
which 765 were in the control group and 783 in the experimental group. Compared with standard care,
music therapy can significantly increase the score of the overall quality of life in patients with cancer. In
addition, music therapy was found to be more effective for decreasing the score of anxiety, depression
and pain.

Music Therapy for Surgical Patients Approach for Managing Pain and Anxiety (2020), The
purpose of this project was to incorporate and evaluate MT as an adjunct intervention to address pain
and anxiety in adult surgical step-down patients. Evidence-based practice change using the 8A's method
integrated individualized MT provided by a board-certified music therapist to hospitalized patients over
a 3-month period. Training was provided to 35 nurses and unit-assigned social worker on the utilization
of MT for patients exhibiting pain or anxiety symptoms. The clinical social worker and staff nurses
provided referrals for MT directly to the music therapist. Evaluation of MT included paired t-test and
Wilcoxon signed-rank score comparisons of the numerical pain rating scale and the DSM-5 Patient
Reported Outcome Measurement Information System Anxiety short form before and after the MT
encounter. Among patients who received MT (n = 42), there was a statistically significant reduction in
both pain (pre = 6.07, post = 3.45, t = 7.046, P = < .001) and anxiety (pre = 56.47, post =
24
46.52, t = 7.787, P ≤ .001). The reduction in pain (moderate to mild) and anxiety (mild to none) was also
clinically significant.

Outcomes of Music Therapy Interventions on Symptom Management in Palliative Medicine

Patients (2017), The purpose of this study was to understand the impact of music therapy sessions;

identify common music therapy goals and interventions and assess their effect; and investigate the
effects of gender, age, and type of cancer on symptoms in patients who experienced music therapy.This
was a retrospective study of data collected during music therapy sessions. Patients scored their
symptoms (pain, anxiety, depression, shortness of breath, and mood) before and after sessions. Data
collected from over 1500 patients included symptom evaluation, goals, interventions, music used,
patient/family reactions, and narratives. Among 293 patients who met all study inclusion criteria,
significant improvement in pain, anxiety, depression, shortness of breath, mood, facial expression, and
vocalization scores was noted. In addition, 96% of patients had positive responses to participating in
music therapy. Vocal and emotional were the 2 most effective interventions in improving symptoms. All
5 patient-reported symptoms improved when the therapist focused on these symptoms as goals. Age,
gender, and diagnosis had no impact on symptom improvement.

Music therapy treatments in an inpatient setting—A randomized pilot study (2020), A sample of
26 patients (12 male and 14 female) from the General Medicine Ward were recruited and randomly
assigned to a treatment group (n = 12) and control group (n = 14). The treatment group received 30-
minutes of individualized music therapy sessions for five consecutive days; they are compared to
standard care in the control group. Pain and mood were measured using a Visual Analog Scale, and
stress, anxiety and depression were measured using the Depression, Anxiety and Stress Scale (DASS
21). Results showed a statistically significant difference in mood, pain and anxiety, but not in depression
and stress scores. Moreover, participants in the treatment group showed more hospital satisfaction
compared to those in the control group.

The Effectiveness of Music Therapy for Terminally Ill Patients: A Meta-Analysis and Systematic
Review (2019), To assess the effectiveness of music therapy during palliative care in improving
physiology and psychology outcomes. Randomized controlled trials evaluating music therapy for
terminally ill patients were searched and included from inception up to April 25, 2018. The quality of
the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook V.5.1.0. In
this study, 11 randomized controlled trials (inter-rater agreement, κ = 0.86) involving 969 participants
were included. The quality of the included studies ranged from moderate to high. Compared with
general palliative care, music therapy can reduce pain (standardized mean difference: −0.44, 95%
25
confidence interval: −0.60 to −0.27, P < 0.00001) and improve the quality of life (standardized mean
difference: 0.61, 95% confidence interval: 0.41 to 0.82, P < 0.00001) in terminally ill patients. In
addition, anxiety, depression, and emotional function are improved as well. However, no significant
differences were found in the patient's physical status, fatigue, and social function.
Music therapy for depression (2017), To assess effects of music therapy for depression in people
of any age compared with treatment as usual (TAU) and psychological, pharmacological, and/or other

therapies and to compare effects of different forms of music therapy for people of any age with a
diagnosis of depression. We included in this review nine studies involving a total of 421 participants,
411 of whom were included in the meta‐analysis examining short ‐term effects of music therapy for
depression. Findings of the present meta‐analysis indicate that music therapy provides short ‐term
beneficial effects for people with depression. Music therapy added to treatment as usual (TAU) seems to
improve depressive symptoms compared with TAU alone. Additionally, music therapy plus TAU is not
associated with more or fewer adverse events than TAU alone. Music therapy also shows efficacy in
decreasing anxiety levels and improving functioning of depressed individuals.

Effects of a Music Therapy Strategy on Depressed Older Adults (2017), A music-facilitated

psychoeducational strategy was developed as a cost-effective and accessible intervention for older adults
experiencing symptoms of depression, distress, and anxiety. Thirty older adults who had been diagnosed
with major or minor depressive disorder were randomly assigned to one of three 8-week conditions: (1)
a home-based program where participants learned music listening stress reduction techniques at weekly
home visits by a music therapist; (2) a self-administered program where participants applied these same
techniques with moderate therapist intervention (a weekly telephone call); or (3) a wait list control.
Participants in both music conditions performed significantly better than the controls on standardized
tests of depression, distress, self-esteem, and mood. These improvements were clinically significant and
maintained over a 9-month follow-up period. The potential for this type of intervention with homebound
elders and others who have limited access to services is discussed.

Music therapy in generalized anxiety disorder (2015), This study proposes music therapy as a
novel approach in clinical psychiatry for generalized anxiety disorder (GAD), which is one of the most
common and incapacitating mental disorders. In this study, we present the results of a pilot intervention
with patients under clinical control and receiving pharmacotherapy. Music therapy was used to decrease
the symptomatology of this disorder following a structured protocol. The pilot study group consisted of
seven patients with no comorbidities. The patients were characterized by Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and were diagnosticated by psychiatrists
at National Institute of Psychiatry Ramón de la Fuente Muñiz. The researchers programmed 12 × 2 h
26
sessions for this group of patients. A pre-test/post-test design using the Beck Anxiety and Depression
Inventory was used. The Wilcoxon statistical test for related groups in global scores demonstrated a
significant reduction after the intervention. The results demonstrate that music therapy was effective in
reducing anxiety and depression levels in GAD patients. Additional studies are required to corroborate
these pilot data.

An evaluation of the effect of group music therapy on stress, anxiety and depression levels in
nursing home residents (2011),A randomized controlled trial was conducted to evaluate the effect of

music therapy on stress, anxiety, and depression levels of a group of the elderly who resided in a nursing
home, The intervention group received 10 weeks of daily music-based sessions (each 90 minutes)
including listening to music, singing and playing percussion instruments, while the control group (no
music) received daily regular activities. The 21- item Depression Anxiety Stress Scale was used as a
pre-and post-intervention measure in each group. Differences in pre- and post-intervention scores
indicated significant reductions in mean scores of anxiety (P = .004), stress (P = .001), and depression (P
&lt; .001) in the intervention group as compared with the control group (no music).

Music therapy for stress reduction: a systematic review and meta-analysis (2020), Music therapy
is increasingly being used as an intervention for stress reduction in both medical and mental healthcare
settings. Music therapy is characterized by personally tailored music interventions initiated by a trained
and qualified music therapist, which distinguishes music therapy from other music interventions, such as
‘music medicine’, which concerns mainly music listening interventions offered by healthcare
professionals. To summarize the growing body of empirical research on music therapy, a multilevel
meta-analysis, containing 47 studies, 76 effect sizes and 2.747 participants, was performed to assess the
strength of the effects of music therapy on both physiological and psychological stress-related outcomes,
and to test potential moderators of the intervention effects. Results showed that music therapy showed
an overall medium-to-large effect on stress-related outcomes (d = .723, [.51–.94]). Larger effects were
found for clinical controlled trials (CCT) compared to randomized controlled trials (RCT), waiting list
controls instead of care as usual (CAU) or other stress-reducing interventions, and for studies conducted
in Non-Western countries compared to Western countries. Implications for both music therapy and
future research are discussed

SCHEMATIC REPRESENTATION OF RESEARCH DESIGN

27
 RESEARCH APPROCH

RESEARCH DESIGN
ONE GROUP PRETEST & POSTTEST

STUDY SETTING
KRISHNA HOSPITAL

TARGET POPULATION
CRITICAL UNIT PATIENTS

SAMPALING TECHNIQUE
PURPUSIVE

SAMPLE SIZE
50 PATIENTS IN CRITICAL CARE UNIT

TOOLS
 Hamilton depression
rating scale
28
 Hamilton anxiety
rating scale
29
 Research methodOLogy

CHAPTER 3

RESEARCH METHODOLOGY

The research methodology followed to assess the knowledge and attitude towards depression,
Anxiety, Stress and Pain among patients admitted in critical care unit in urban area of karad taluka.

Research approach, Research design , Research setting, population , sample , sample size, sampling
technique , criteria for sample selection and data analysis procedure used in this study.

RESEARCH APPROACH:

The selection of research approach is a basic procedure for the conduct of research enquires in view of
nature of the problem selection for the study and objectives to be accomplished. A descriptive study
approach used to assess knowledge and attitude towards depression, anxiety, stress, and pain among
patients admitted in critical care unit.

30
RESEARCH DESIGN:

The study is true experimental one group pre-test and post-test design will be used. The observational
study data will be conducted and qualitatively analyzed.

RESEARCH SETTING:

The setting of the study will be conducted at selected hospital i.e. Krishna Hospital Karad.

POPULATION:

Patient admitted In Critical Care Unit of Krishna Hospital Karad.

SAMPLE:

For the present study the samples were selected from the critical care unit of Krishna Hospital Karad.
The sample chosen for the study consist of 50 patients.

SAMPLE SIZE:

50 patients in critical care unit admitted in selected hospital.

SAMPLING TECHNIQUE:

Forthe present study we have used selected peoples in the critical care unit.

SAMPLE CRITERIA:

Inclusion criteria:

1. Patients those were present at the time of data collection.

2. Patients who know Marathi, Hindi, English.
3. Participant who are willing to participate.

Exclusion criteria:

1. Patients who not available during the period of data collection.

31
METHODS OF DATA COLLECTION

 Firstly, we have to take permission from head of institution for conducting research
study into the hospital
 Then the take permission of the medical director for conducting research into the
critical care unit
 Then conduct inclusion and exclusion criteria
 Then take patient consult
 Assess the pretest
 Then do the music intervention by the selected patient
 Then assess the post test

TOOL OF DATA COLLECTION:

For the present study we used music therapy for the purposes of the study. Tool used for the
study is:

 Hamilton depression rating scale

 Hamilton anxiety rating scale

 Perceived rating scale

 Pain rating scale

METHOD OF DATA ANALYSIS:

The plan of data analysis was as follows:

a) Organized data in a master sheet on the computer.

b) Socio demographic data analyzed in terms of frequencies and percentages.
c) Classified the knowledge score by poor, average and good:
32
  Paired t-test was done to assess the level of anxiety, depression, stress and pain with
the pre-test and post-test.
 Chi-square test was done to associate the level of knowledge with in the socio
demographic data.

SUMMARY:
This chapter of research methodology has deals with research approach, research
design,population, sample, sample size, sample technique, tool of data collection, process of data
collection and method of data collection.

33
 ANALYSIS AND
INTERPRETATION

CHAPTER 4

ANALYSIS AND INTERPRETATION

The term analysis refers to the computation of certain measures along with searching of patterns of
relationships that exit among data group. Analysis of data in general way involves a number of closely
related operations, which are performed with the purpose of summarizing the collected data organising
this in such a manner that they answer the question.

Collected data were coded, tabulated, organized, analysed and interpreted. The data has been
analyzed and interpreted in the light of objectives and hypothesis of the study.

Objective of the study:

a) Assess level of depression among critically ill patients admitted in Critical Care Unit.
b) Assess level of anxiety among patients admitted in critical care unit.
34
 c) Assess level of Stress among patients admitted in critical care unit.
d) Assess level of pain among critically ill patients admitted in critical care unit.
e) Assess music interventions on depression among patients admitted in critical care unit.
f) Assess music intervention on anxiety among patients admitted in ICU.
g) Assess music interventions on stress admitted in critical care unit.
h) Assess music interventions on the patients admitted in critical care unit.
i) To find out association between depression and socio-demographic variables
j) To find out association between anxiety and socio-demographic variables
k) To find out association between stress and socio-demographic variables.
l) To find out association between Pain and socio-demographic variables.

Organization of Finding:

The data analyzed were presented under the following section:

Section 1: Frequency and Percentage distribution of demographic variables of participants.

Section 2: Assess level of depression, anxiety, stress and pain among critically ill patients admitted in
Critical Care Unit.

Section 3: Assess music interventions on depression, anxiety, stress and pain among patients admitted in
critical care unit.
Section 4:To find out association between depression and socio-demographic variables.
Section 5: To find out association between anxiety and socio-demographic variables

Section 6: To find out association between stress and socio-demographic variables.

Section 7: To find out association between Pain and socio-demographic variables.

35
 SOCIO-
SR. NO. DEMOGRAPHIC CATEGORIES FREQUENCY PERCENTAGE
VARIABLES
1 AGE 21-40 18 36
41-60 19 38
61-80 13 26
2 GENDER MALE 29 58
FEMALE 21 42
3 EDUCATION ILLITRATE 6 12
PRIMARY 18 36
SECONDARY 13 26
GRADUATE 13 26
POST 00 00
GRADUATE
4 MARITAL STATUS MARRIED 43 86
UNMARRIED 7 14
5 OCCUPATION ACTIVE 29 58
INACTIVE 21 42
6 RESIDENCE URBAN 9 18
RURAL 41 82

Section 1: Frequency and Percentage distribution of demographic

variables of participants.

36
 AGE
36% 26%
100% 38%
90%
80%
70%
60% %
50%
40%
30%
20%
10%
0%
21-40 41-60 61-80
1 2 3

Figure 1: Distribution of samples according to their age.

With regards to age 36% is within 21 to 40 years old, 38% is within 41 to 60 years old, 26% is within 61
to 80 years old.

GENDER

42% 1 MALE
58% 2 FEMALE

Figure 2: Distribution of samples according to their gender.

With regards to gender, 42% female and 58% male.

37
 EDUCATION

1 ILLITRATE
12%
26% 2 PRIMARY
3 SECONDARY
4 GRADUATE
5 POST GRADUCATE
36%
26%

Figure 3: Distribution of samples according to their education

With regards to education, 12% illetrate, 36% primary, 26% secondary, 26% graduate, 0% post graduate

MARITAL STATUS

14%
1 MARRIED
2 UNMARRIED

86%

Figure 4: Distribution of samples according to their marital status

With regards to marital status, 86% married and 14% unmarried.

38
 OCCUPATION

58% 42%
100%
90%
80%
70% %
60%
50%
40%
30%
20%
10%
0%
ACTIVE INACTIVE
1 2

Figure 5: Distribution of samples according to their Occupation.

With regards to occupation, 58% active and 42% inactive

RESIDENCE

100%
90%
80%
70% %
60% 18% 82%
50%
40%
30%
20%
10%
0%
URBAN RURAL
1 2

Figure 6: Distribution of samples according to their residence.

With regards to residence, 18% urban and 82% rural.

39
Section 2: Assess level of depression anxiety stress and pain among
critically ill patients admitted in Critical Care Unit.

TABLE 2: COMPARISION OF DEPRESSION (Pretest)

FREQUENCY PERCENTAGE
Mild (0 to 13) 2 4%
Moderate (14 to17) 0 0%
Severe (more than 17) 48 96%

DEPRESSION PRETEST
4% 96%
100%
90%
80%
70%
60% PERCENTAGE
50%
40%
30%
20%
0%
10%
0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

Table4: DEPRESSION POST TEST

FREQUENCY PERCENTAGE
Mild (0 to 13) 47 94%
Moderate (14 to17) 1 2%
Severe (more than 17) 2 4%

40
 DEPRESSION POSTTEST
94% 2% 4%
100%
90%
80%
70%
60% PERCENTAGE
50%
40%
30%
20%
10%
0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

TABLE 5: COMPARISION OF ANXIETY Pretest

FREQUENCY PERCENTAGE
Mild (less than 17) 1 2%
Moderate (18 to 24) 1 2%
Severe (More than 25) 48 96%

ANXIETY PRETEST
96%
100%
90%
80%
70%
60% PERCENTAGE
50%
40%
30%
20% 2% 2%
10%
0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

41
TABLE6: COMPARISION OF ANXIETY Post test

FREQUENCY PERCENTAGE
Mild (less than 17) 37 74%
Moderate (18 to 24) 11 22%
Severe (above 25) 2 4%

ANXIETY POSTTEST

80%
70%
60%
50% PERCENTAGE
40% 74%
30%
20%
22%
10%
4%
0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

TABLE 7: COMPARISION OF STRESS SCALE Pretest

FREQUENCY PERCENTAGE
Mild (0 to 13) 2 4%
Moderate (14 to 26) 48 96%
Severe (27 to 40) 0 0%

42
 STRSS PRETEST
100%
90%
80%
70%
60% PERCENTAGE
4% 96%
50%
40%
30%
20%
10%
0% 0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

TABLE 8: COMPARISION OF STRESS SCALE Post test

FREQUENCY PERCENTAGE
Mild (0 to 13) 6 12%
Moderate (14 to 26) 43 86%
Severe (27 to 40) 1 2%

STRESS POSTTEST

90%
80%
70%
60%
PERCENTAGE
50% 86%
40%
30%
20%
10% 12%
2%
0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

43
TABLE 9: COMPARISION OF PAIN SCALE Pretest

FREQUENCY PERCENTAGE
Mild (1 to 3) 1 2%
Moderate (4 to 6) 31 62%
Severe (7 to 10) 18 36%

PAIN PRETEST
100%
90%
80%
70%
60% PERCENTAGE
2% 62% 36%
50%
40%
30%
20%
10%
0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

TABLE 10: COMPARISION OF PAIN SCALE Post test

FREQUENCY PERCENTAGE
Mild (0 to 3) 32 64%
Moderate (4 to 6) 18 36%
Severe (7 to 10) 0 0%

44
 PAIN POSTTEST
100%
90%
80%
70%
60% PERCENTAGE
64% 36%
50%
40%
30%
20%
10%
0% 0%
Mild (0 to 13) Moderate (14 Severe (more
to17) than 17)

Section 3: Assess music interventions on depression, anxiety, stress and

pain among patients admitted in critical care unit.

TABLE 11: COMPARISION OF PRETEST AND POST TEST

Level of Scoring Pre-Test Post- Test

Depression Frequency Percentage Frequency Percentage
Mild (0 to 13) 2 4% 47 94%
Moderate (14 to17) 0 0% 1 2%
Severe (more than 48 96% 2 4%
17)

45
 94% 96%
100%
90%
80%
70%
60%
50% Pretest
40% Postest

30%
20%
4% 2% 4%
10% 0%
0%
Mild (0 to 13) Moderate (14 Severe (more than
to17) 17)

Level of Scoring Pre-Test Post- Test

Anxiety Frequency Percentage Frequency Percentage
Mild (less than 17) 1 2% 37 74%
Moderate (18 to 24) 1 2% 11 22%
Severe (More than 48 96% 2 4%
25)

96%
100%
90%
74%
80%
70%
60%
50% Pretest
40% Posttest

30% 22%
20%
2% 2% 4%
10%
0%
Mild (0 to 13) Moderate (14 Severe (more than
to17) 17)

46
Level of Scoring Pre-Test Post- Test
Stress Frequency Percentage Frequency Percentage
Mild (0 to 13) 2 4% 6 12%
Moderate (14 to 26) 48 96% 43 86%
Severe (27 to 40) 0 0% 1 2%

96%
100%
86%
90%
80%
70%
60%
50% Pretest
40% Posttest

30%
20% 12%
4% 2%
10% 0%
0%
Mild (0 to 13) Moderate (14 Severe (more than
to17) 17)

Level of Pain Scoring Pre-Test Post- Test

Frequency Percentage Frequency Percentage
Mild (1 to 3) 1 2% 32 64%
Moderate (4 to 6) 31 62% 18 36%
Severe (7 to 10) 18 36% 0 0%

47
70% 64% 62%

60%

50%
36% 36%
40%
Pretest
30% Posttest

20%

10% 2% 0%
0%
Mild (0 to 13) Moderate (14 Severe (more than
to17) 17)

48
Section 4:To find out association between depression and socio-
demographic variables.
TABLE 10: Association between Depression (Pretest)

Demographic Level of Depression Chi square P value Interpretation

variables Mild Moderate Severe value
1.AGE
21-40 Years 0 0 18
41-60 Years 1 0 18 1.290 0.5245 NA
61-80 Years 1 0 12
2.GENDER
MALE 01 0 28 0.05473 0.8150 NA
FEMALE 01 0 20
4.EDUCATION
ILLITRATE 0 0 6
PRIMARY 2 0 16
SECONDARY 0 0 13 3.704 0.2953
GRADUATE 0 0 13
POST GRADUATE 0 0 0
5.MARITAL STATUS
MARRIED 2 0 41 0.3391 0.5603 NA
UNMARRIED 0 0 7
6.OCCUPATION
ACTIVE 2 0 27 1.509 0.2193
INACTIVE 0 21
7.RECIDENCE
URBAN 0 0 9 0.4573 0.4989
RURAL 2 0 39

49
Section 5: To find out association between anxiety and socio-demographic
variables
Table 11: Association between anxiety (pretest)

Demographic Level of Anxiety Chi square P value Interpretation

variables Mild Moderate Severe value
1.AGE
21-40 Years 0 0 14
41-60 Years 0 1 13 1.833 0.4000 NA
61-80 Years 0 0 11
2.GENDER
MALE 1 0 27 2.060 0.3571
FEMALE 0 1 21 NA
4.EDUCATION
ILLITRATE 0 0 6
PRIMARY 1 1 16
SECONDARY 0 0 13 3.704 0.7167 NA
GRADUATE 0 0 13
POST GRADUATE 0 0 0
5.MARITAL STATUS
MARRIED 1 1 41 0.3391 0.8440 NA
UNMARRIED 0 0 7
6.OCCUPATION
ACTIVE 1 1 27 1.509 0.4703
INACTIVE 0 0 21 NA
7.RECIDENCE
URBAN 1 0 9 4.297 0.1167
RURAL 0 1 39 NA

50
Section 6: To find out association between stress and socio-demographic
variables.
Table 12: Association between stress (pretest)

Demographic Level of Stress Chi square P value Interpretation

variables Mild Moderate Severe value
1.AGE
21-40 Years 0 18 O
41-60 Years 1 18 O 1.290 0.5245 NA
61-80 Years 1 12 O
2.GENDER
MALE 2 27 0 1.509 0.2193
FEMALE 0 21 0 NA
4.EDUCATION
ILLITRATE 0 6 0
PRIMARY 2 16 0
SECONDARY 0 13 0 3.704 2.953 NA
GRADUATE 0 13 0
POST GRADUATE 0 0 0
5.MARITAL STATUS
MARRIED 2 41 0 0.3391 0.5603 NA
UNMARRIED 0 7 0
6.OCCUPATION
ACTIVE 2 27 0 1.509 0.2193
INACTIVE 0 21 0 NA
7.RECIDENCE
URBAN 0 9 0 0.4573 0.4989
RURAL 2 39 NA

51
Section 7: To find out association between Pain and socio-demographic
variables.

Table 13:Association between pain (pretest)

Demographic Level of Pain Chi square P value Interpretation

variables Mild Moderate Severe value
1.AGE
21-40 Years 0 13 5 3.987 0.4201
41-60 Years 0 11 8 NA
61-80 Years 1 7 5
2.GENDER
MALE 1 19 9 1.335 0.5130 NA
FEMALE 0 12 9
4.EDUCATION
ILLITRATE 0 1 5
PRIMARY 1 13 4
SECONDARY 0 8 5 8.984 0.1745 NA
GRADUATE 0 9 4
POST GRADUATE 0 0 0
5.MARITAL STATUS
MARRIED 1 27 15 0.3001 0.8607 NA
UNMARRIED 0 4 3
6.OCCUPATION
ACTIVE 1 19 9 1.335 0.5130 NA
INACTIVE 0 12 9
7.RECIDENCE
URBAN 0 4 5 1.931 0.3808
RURAL 1 27 13 NA

52
COMPARISION OF PRETEST AND POST TEST OF DEPRESSION

pretest Post test Mean

difference

SD 7.181 5.437174 1.74

MEAN 40 9.78 30.22

COMPARISION OF PRE TEST AND POST TEST OF ANXIETY

53
 pretest Post test Mean
difference

SD 6.519 8.458784 1.9

MEAN 45.44 13 32.44

COMPARISON OF PRETEST AND POST TEST OF STRESS

54
 pretest Post test Mean P value
difference

SD 3.130 3.165438 0.035

MEAN 21.96 17.02 4.94

COMPARISON OF PRETEST AND POST TEST OF

STRESS

25 21.96

20 17.02

15

10
3.13 3.165438
5

0
1 2

SD MEAN

COMPARISON OF PRETEST AND POST TEST OF PAIN

55
 pretest Post test Mean
difference

SD 1.449 1.228904 0.22

MEAN 5.94 3.2 2.74

56
DISCUSSION AND
SUMMARY

Chapter 5

Discussion and conclusion

57
 The chapter attempts to discuss the significant findings. The discussion section links the results
of your research to the conclusions you are drawing, explaining how you use your data to explain your
results. Before you present your data, you should explain again,very briefly, the purpose and scope of
your research study. It should focus on explaining and evaluating what you found, showing how it
relates to your literature review and research questions and making an argument in support of your
overall conclusion.

This chapter discusses with the finding of data analysis in accordance with objectives and stated
hypotheses of the present study. The statement of the problem was “A study to assess the effectiveness
of music intervention on depression, anxiety, stress and pain among patients admitted in critical
care unit”

Findings of the Study:

The finding of the study wereanalyzed by using frequency, percentage distribution.

The result was checked with other studies.

Anna Maratos, Christina Gold, Xu Wang and Mike Crawford (2008):

They conducted five studies met the inclusion criteria of the review. Marked variations in the
interventions offered and the populations studied meant that meta ‐analysis was not appropriate. Four of
the five studies individually reported greater reduction in symptoms of depression among those
randomised to music therapy than to those in standard care conditions. The fifth study, in which music
therapy was used as an active control treatment, reported no significant change in mental state for music
therapy compared with standard care. Dropout rates from music therapy conditions appeared to be low
in all studies.Findings from individual randomised trials suggest that music therapy is accepted by
people with depression and is associated with improvements in mood. In our study we found that the
patients was having depression before giving music therapy and after giving music therapy it has
reduced to some extend. Our study aim was attained after intervention. There is no any association
between the demographic variable and pre-test.

58
Anne Horne Thompson and Denise Grocke (2008):

Twenty-five participants with end-stage terminal disease receiving inpatient hospice services
were recruited. Results demonstrated a significant reduction in anxiety for the experimental group on the
anxiety measurement of the ESAS (p = 0.005). A post hoc analysis found significant reductions in other
measurements on the ESAS in the experimental group, specifically pain (p = 0.019), tiredness (p =
0.024) and drowsiness (p = 0.018). The study supports the use of music therapy to manage anxiety in
terminally ill patients. . In our study we found that the patients was having anxiety before giving music
therapy and after giving music therapy it has reduced to some extend. Our study aim was attained after
intervention. There is no any association between the demographic variable and pre-test.

Martina, Ana, Xavier, Arjan and Susan (2020):

2.747 participants, was performed to assess the strength of the effects of music therapy on both
physiological and psychological stress-related outcomes, and to test potential moderators of the
intervention effects. Results showed that music therapy showed an overall medium-to-large effect on
stress-related outcomes (d = .723, [.51–.94]). Larger effects were found for clinical controlled trials
(CCT) compared to randomized controlled trials (RCT), waiting list controls instead of care as usual
(CAU) or other stress-reducing interventions, and for studies conducted in Non-Western countries
compared to Western countries. The current meta-analytic review provides evidence that music
therapy can be effective in reducing stress and provides justifications for the increasing use of music
therapy carried out by a qualified music therapist in both mental health care practice and medical
settings. In our study we found that the patients was having stress before giving music therapy and after
giving music therapy it has reduced to some extend. Our study aim was attained after intervention.
There is no any association between the demographic variable and pre-test.

Kathy, Seughee, Peter, Janice, Mariel and Clareen( 2013):

Two hundred inpatients at University Hospitals Case Medical Center were enrolled in the study from
2009 to 2011. Patients were randomly assigned to one of two groups: standard care alone (medical and
nursing care that included scheduled analgesics) or standard care with music therapy. A clinical nurse
specialist administered pre- and post-tests to assess the level of pain using a numeric rating scale. A
significantly greater decrease in numeric rating scale pain scores was seen in the music therapy group.
In our study we found that the patients was having pain before giving music therapy and after giving

59
music therapy it has reduced to some extend. Our study aim was attained after intervention. There is no
any association between the demographic variable and pre-test.

Summary and Conclusion

This chapter deals with the conclusion, implication, recommendation and limitations of the study. The
statement of the problem is “A study to assess the effectiveness of music intervention on depression,
anxiety, stress and pain among patients admitted in critical care unit”

OBJECTIVE OF THE STUDY:

a) Assess level of depression among critically ill patients admitted inCritical Care Unit.
b) Assess level of anxiety among patients admitted in critical care unit.
c) Assess level of Stress among patients admitted in critical care unit.
d) Assess level of pain among critically ill patients admitted in critical care unit.
e) Assess music interventions on depression among patients admitted in critical care unit.
f) Assess music intervention on anxiety among patients admitted in ICU.
g) Assess music interventions on stress admitted in critical care unit.
h) Assess music interventions on the patients admitted in critical care unit.
i) To find out association between depression and socio-demographic variables
j) To find out association between anxiety and socio-demographic variables
k) To find out association between stress and socio-demographic variables.
l) To find out association between Pain and socio-demographic variables

This study aimed to explore to explore the use of music therapy in reducing the depression,
anxiety, stress and pain of patients who are admitted in the critical care unit. This study demonstrated
that music therapy had a significant effect in decreasing depression, anxiety, stress and pain of patient
admitted in critical care unit. Music therapy also played an important role in reducing the emotional
factors of the patient.

Limitation:

60
  This study only assessed patients who were admitted in critical care unit.
 A large no of samples could not be taken because of the time constraints.
 The sample size was considered for the generalization population.

Recommendation:

 Same study can be carried out on larger population of patients.

 Similar study can be conducted among different patients suffering from other health issue

REFERENCE

 Tang, Qishou, et al. "Effects of music therapy on depression: A meta-analysis of

randomized controlled trials." PloS one 15.11 (2020): e0240862.

61
 Lu, Guangli, et al. "Effects of music therapy on anxiety: A meta-analysis of
randomized controlled trials." Psychiatry Research 304 (2021): 114137.
 de Witte, Martina, et al. "Music therapy for stress reduction: a systematic review
and meta-analysis." Health Psychology Review 16.1 (2022): 134-159.
 Wong, H. L. C., Violeta Lopez-Nahas, and A. Molassiotis. "Effects of music
therapy on anxiety in ventilator-dependent patients." Heart & Lung 30.5 (2001):
376-387.
 Guetin, Stephane, et al. "Effect of music therapy on anxiety and depression in
patients with Alzheimer’s type dementia: randomised, controlled study." Dementia
and geriatric cognitive disorders 28.1 (2009): 36-46.
 de la Rubia Ortí, Jose Enrique, et al. "Does music therapy improve anxiety and
depression in alzheimer'spatients?." The Journal of Alternative and
Complementary Medicine 24.1 (2018): 33-36.
 Wu, Shwu Ming. "Effects of music therapy on anxiety, depression and self-esteem
of undergraduates." Psychologia 45.2 (2002): 104-114.
 Lin, Chiao‐Ling, et al. "Effect of music therapy on pain after orthopedic surgery—
a systematic review and meta‐analysis." Pain Practice 20.4 (2020): 422-436.
 Li, Yanfei, et al. "The effectiveness of music therapy for patients with cancer: A
systematic review and meta‐analysis." Journal of Advanced Nursing 76.5 (2020):
1111-1123.
 Bojorquez, Genesis R., Kimmeth E. Jackson, and Amy K. Andrews. "Music
therapy for surgical patients: approach for managing pain and anxiety." Critical
care nursing quarterly 43.1 (2020): 81-85.
 Gramaglia, Carla, et al. "Outcomes of music therapy interventions in cancer
patients—A review of the literature." Critical Reviews in
Oncology/Hematology 138 (2019): 241-254.
 Tan, Patsy, Laurence H. Lester, and Antonina Maria Lin. "Music therapy
treatments in an inpatient setting—A randomized pilot study." The Arts in
Psychotherapy 69 (2020): 101660.
 Gao, Yinyan, et al. "The effectiveness of music therapy for terminally ill patients:
a meta-analysis and systematic review." Journal of pain and symptom
management 57.2 (2019): 319-329.
62
  Aalbers, Sonja, et al. "Music therapy for depression." Cochrane database of
systematic reviews 11 (2017).
 Hanser, Suzanne B., and Larry W. Thompson. "Effects of a music therapy strategy
on depressed older adults." Journal of gerontology 49.6 (1994): P265-P269.
 Gutiérrez, Enrique Octavio Flores, and Víctor Andrés Terán Camarena. "Music
therapy in generalized anxiety disorder." The Arts in Psychotherapy 44 (2015): 19-
24.
 Mohammadi, Ali Zadeh, TanazeShahabi, and Fereshteh Moradi Panah. "An
evaluation of the effect of group music therapy on stress, anxiety and depression
levels in nursing home residents." Canadian Journal of Music Therapy 17.1
(2011).
 de Witte, Martina, et al. "Music therapy for stress reduction: a systematic review
and meta-analysis." Health Psychology Review 16.1 (2022): 134-159.

APPENDIX A

63
APPENDIX B:

64
APPENDIX C:
65
APPENDIX D
66
TOOL FOR DATA COLLECTION

Title of the Research Project:

EFFECTIVENESS OF MUSIC INTERVENTION ON DEPRESSION, ANXIETY,

STRESS AND PAIN AMONG PATIENTS ADMITTED IN CRITICAL CARE UNIT.

Demographic Data:
a) Age
b) Gender
1. Male
2. Female.
b) Education
1. None
2. Primary
3. secondary
4 .graduation
5.post graduation
6.others
c) Marital status
- Married
- Unmarried
d) Occupation.
1. Working
2. Non working
e) Residence -
1. Urban
2. Rural

67
HAMILTON DEPRESSION RATING SCALE

The total Hamilton Depression (HAM-D) Rating Scale provides and indication of
depression and, over time, provides a valuable guide to progress.

 Classification of symptoms which may be difficult to

obtain can be scored as: 0 - absent: 1:doubtful
or trivial: 2 -present.
 Classification of symptoms where more detail can be
obtained can be expanded to: 0 - absent; 1 - mild; 2 -
moderate; 3 - severe; 4 -incapacitating.
 In general the higher the total scores the more severe thedepression.
 HAM-D score level of depression:

10 - 13 mild; 14-17 mild to moderate; >17 moderate to severe.

Assessment is recommended at two weekly intervals.

68
 HAM-D Rating Scale Symptoms
1 Depressed mood 01234
2 Guilt feelings 01234
3 Suicide 01234
4 Insomnia - early 012
5 Insomnia - middle 012
6 Insomnia - late 012
7 Work and activities 01234
8 Retardation - psychomotor 01234
9 Agitation 01234
1 Anxiety - psychological 01234
0
1 Anxiety - somatic 01234
1
1 Somatic symptoms GI 012
2
1 Somatic symptoms - General 012
3
Sexual dysfunction -
1 menstrual disturbance 012
4
1 Hypochondrias 01234
5
1 Weight loss by history 012
6
- by scales 012
1 Insight 012
7

TOTAL SCORE

Hamilton M. Development of a rating scale; for primary depressive illness. Br J

Soc Clin Psychol. 1967 Dec;6(4):278-96. No permission is required to use this
tool.
69
Scoring: Each item is scored on a scale of 0 (not present) to 4
(severe),withatotalscorerangeof0–56,
Where<17indicatesmildseverity,18–24mildtomoderateseverityand 25–30
moderate to severe.

70
Scoring:
PSS scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1
& 4 = 0) to the four positively stated items (items 4, 5, 7, & 8) and then
summing across all scale items. A short 4 item scale can be made from
questions 2, 4, 5 and 10 of the PSS 10 item scale.

71
72