EFFECTIVENESS OF MUSIC THERAPY ON PAIN

AMONG CHILDREN UNDERGONE SURGICAL

PROCEDURES IN INSTITUTE OF CHILD HEALTH
AND RESEARCH CENTRE AT GOVERNMENT
RAJAJI HOSPITAL MADURAI

M.Sc (NURSING) DEGREE EXAMINATION

BRANCH II – CHILD HEALTH NURSING

COLLEGE OF NURSING, MADURAI MEDICAL COLLEGE,
MADURAI -20.

 
 
 
 
 
 
 
 
 
 

 
 

A dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,
CHENNAI - 600 032.
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING

APRIL 2015
EFFECTIVENESS OF MUSIC THERAPY ON PAIN AMONG
CHILDREN UNDERGONE SURGICAL PROCEDURESIN
INSTITUTE OF CHILD HEALTH AND RESEARCH CENTRE
AT GOVERNMENT RAJAJI HOSPITAL MADURAI.

Approved by Dissertation committee on………………………………

Professor in Nursing Research ___________________________

Mrs.S.POONGUZHALI, M.Sc (N), M.A, M.BA, PhD

Principal
Department of Medical surgical nursing,
College of Nursing,
Madurai Medical College,
Madurai.

Clinical Specialty Expert ________________

Mrs.N.MAHESWARI, M.Sc (N), M.A,D.P.H.N,PGDGC, M.BA, PhD

Faculty in Child HealthNursing,
Department ofPaediatric Nursing,
College of Nursing
Madurai Medical College,
Madurai.

Medical Expert ___________________

Prof .Dr.G.MATHEVAN, MD.,D.C.H.

Director,
Institute of Child Health and Research Centre,
Government Rajaji Hospital,
Madurai.

 
A dissertation submitted to
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,
CHENNAI- 600 032.
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING

APRIL 2015
 CERTIFICATE

This is to certify that this dissertation titled,EFFECTIVENESS OF

MUSIC THERAPY ON PAIN AMONG CHILDREN UNDERGONE

SURGICAL PROCEDURES IN INSTITUTE OF CHILD HEALTH AND

RESEARCH CENTRE AT GOVERNMENT RAJAJI HOSPITAL

MADURAI.is a bonafide work done by Mrs.A.Magamutha begum, M.Sc (N)

Student, College of Nursing, Madurai Medical College, Madurai-2, submitted to

THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI, in partial

fulfillment of the university rules and regulations towards the award of the degree

of MASTER OF SCIENCE IN NURSING, Branch II, Child Health Nursing,

under our guidance and supervision during the academic period from 2013—2015.

Mrs.S.POONGUZHALI, M.Sc (N), CAPTAIN.Dr.B.SANTHAKUMAR, M.Sc(F.Sc),

M.A., M.B.A., Ph.D., M.D(F.M), PGDMLE, Dip.N.B(F.M).,
PRINCIPAL, DEAN,
COLLEGE OF NURSING, MADURAIMEDICAL COLLEGE,
MADURAI MEDICAL COLLEGE, MADURAI-20.
MADURAI-20.
 CERTIFICATE

This is to certify that the dissertation entitledEFFECTIVENESS OF

MUSIC THERAPY ON PAIN AMONG CHILDREN UNDERGONE

SURGICAL PROCEDURES IN INSTITUTE OF CHILD HEALTH AND

RESEARCH CENTRE AT GOVERNMENT RAJAJI HOSPITAL

MADURAI.is a bonafide work done Mrs.A.Magamutha begum, M.Sc (N) Student,

College of Nursing, Madurai Medical College, Madurai- 20, in partial fulfillment of

the University rules and regulations for award of the degree of MASTER OF

SCIENCE IN NURSING, Branch II-Child Health Nursing, under my guidance

and supervision during the academic year 2013—2015.

Name & Signature of the Guide______________________________________

Mrs.N.MAHESWARI, M.Sc (N), M.A, D.P.H.N,PGDGC,M.BA, Ph.D
Faculty in Child Health Nursing,
Department ofChild Health Nursing,
College of Nursing
Madurai Medical College,
Madurai.

Name & Signature of the Head of Department____________________________

Mrs.S.POONGUZHALI, M.Sc (N)., M.A.,M.B.A.,Ph.D
Principal,
College of Nursing,
Madurai Medical College,
Madurai.

Name & Signature of the Dean

CAPTAIN.Dr.B.SANTHAKUMAR, M.Sc (F.Sc),
M.D (F.M), PGDMLE,Dip.N.B(F.M)
Dean,
Madurai Medical College,
Madurai.
 ACKNOWLEDGEMENT

I praise and thank lord,and my mother Almighty for his abundant

graces and blessing showered upon me throughout the study.

I glad to express my sincere thanks to CAPTAIN.Dr.B.Santhakumar

M.Sc(FSc).,M.D.,(F.M).,PGDMLE.,Dip.,N.B (F.M).,Dean, Madurai Medical
College, Madurai for his acceptance and approval for the study.

I wish to express my deep sense of gratitude and heartfelt thanks to

Mrs.S.PoonguzhaliM.Sc(N).,M.A., M.B.A., Ph.D.,Principal, College of Nursing,
Madurai Medical College, Madurai for her constant guidance and support for
successful completion of the study.

I deem it a great privilege to express my sincere gratitude and deep sense of

indebtedness to my esteemed teacher N.Maheswari,M.Sc(N),M.A,D.P.H.N,
PGDGC,M.B.A,Ph.D, Faculty in Child Health Nursing, College of Nursing,
Madurai Medical College, Madurai for her hard work, efforts, interest and sincerity
to mould this study in successful way, which had given inspiration, encouragement
and laid strong foundation on every stage of research.

I wish to strongly express my sincere gratitude to Prof. Dr.G.Mathevan,

M.D., Head of the Department of Pediatrics, Govt. Rajaji Hospital Madurai. for
encouraging and helping me in constructing the tools for my study and completing
the study in a successful manner.

I thankful toDr.N.Karuppasamy, M.S, M.ch., Assistant Professor of

Pediatric Surgery, Madurai Medical College, Madurai. and Mrs.A.Hellen.MSc(N),
Principal in Apollo college of Nursing, Mrs.C.JothiSophia M.SC (N),Ph.D,
Principal in C.S.I JeyarajAnnapackiam college of Nursing , MrsJ.StellaSagaya
Mary, M.SC (N),Vice Principal Matha college of Nursing for validation of the tool
and for valuable suggestions in this study.
 I offer my earnest gratitude to all the Faculty Members of College of Nursing,
Madurai Medical College, Madurai for their assistance and moral support.

My special thanks to Mrs.N.Nagarathinam, M.Sc.,(N) and

Mrs.R.Jeyasundari, M.Sc., (N), M.A.,M.A., M.Phil., for giving the beginning

encourage and laid strong foundation.

I extend my sincere thanks to Mr.V.Mani, M.Sc.,M.Phil,(Bio-

Statistics),Aravind Eye Hospital Madurai for suggestions and statisticalanalysis.

I thankful to Mrs.M.Saratha,M.A.B.ED,M.Phil, (Tamil) Government High

School T.Kallupatti. Mr. T.Venkatesh, M.Sc.,B.Ed.,M.Phil.,M.A
(English)Muthalamman higher secondary school, for editing my dissertation
study.

I thankful to Mr.S.KalaiSelvan, M.A., B.L.I.S., Librarian, College of Nursing,

Madurai Medical College, Madurai, for his cooperation in collecting the related
literature for this study.

Above all, I would like to express my thanks to all the staff members
whoworked in the Surgical post operative wards, Children and their parents
admitted in the Postoperative wards who had interestingly participated in this
study withoutwhom it was not possible for me to complete this study.

It give me immense pleasure to express my affectionate thanks to my

husband Mr.J.MohamedSheriefmy loving Son Master.M.S.MohmedAadil.

My whole hearted thanks and gratitude to one and all who came on my way to
success.

 
 

ABSTRACT

Title:Effectiveness of Music Therapy on Pain Among Children Undergone

Surgical Procedures In Institute of Child Health and Research Centre At
Government Rajaji Hospital Madurai.Objectives :Assess the level of pain among
children undergone surgical procedures in experimental group and control group.
Evaluate the effectiveness of music therapy on pain among children undergone
surgical procedures in experimental group. Compare the post test level of pain
among children undergone surgical procedures in experimental group and control
group.Associate the post-test level of pain among children undergone surgical
procedures with selected demographic variables in both groups.Hypotheses : There
is a significant difference between the level of pain among children undergone
surgical procedures,of experimental group after music therapy.There is a
significant difference in the post test level of pain among children undergone
surgical procedures in experimental group and control group.There is a significant
association in the level of pain among children undergone surgical procedures with
selected demographic variables in both groups. Conceptual Framework:Based on
Modified Imogene King’s Goal Attainment Theory (1981)Methodology:A True
experimental design used to select subject 30exprimental and 30 control group by
simple random sampling at GRH Madurai. Pre test was conducted by Visual analog
scale after obtaining consent, Music therapy given 15 - 20 minutes twice a day for
second and third post operative days. Post test was assessed for both group using
same tool. Findings: The studysuggested that post test pain level less then the
pretest pain level.Conclusion: The study concluded that Music therapy is cost
effective, noninvasive, non pharmacological complementary and alternative therapy
to reduce the level of pain among children undergone surgical procedures.
 TABLE OF CONTENTS
CHAPTER PAGE
TITLE
NO NO
INTRODUCTION
1. 1.1 Need for the study 13

1.2 Statement of the problem 16

1.3 Objectives 16

1.4 Hypotheses 17

1.5 Operational definitions 17

1.6. Assumptions 18

1.7 Limitations 18

1.8 Projected outcome 19

REVIEW OF LITERATURE
2.
2.1 Literature related to pain among children undergone
21
surgical procedures.

2.2 Literature related to Non pharmacological 22

management of postoperative painin children.
2.3 Literature related to effects of music therapy in 25
children.
2.4 Literature related to effects of music therapy on 30
painamong children undergone surgical procedures.
2.5 Conceptual frame work 35
RESEARCH METHODOLOGY
3. 3.1 Research approach 38
3.2 Research design 39
3.3 Variables 40
3.4 Setting of the study 40
3.5 Population 40
3.6 Sample 41
3.7 Sample size 41
3.8 Sampling technique 41
CHAPTER PAGE
TITLE
NO NO
3.9 Criteria for sample selection 42
3.10 Description of the tool and technique 42
3.11 Scoring procedure 43
3.12 Testing of the tool 44
3.13 Pilot study 44
3.14 Intervention 45
3.15 Ethical Consideration 45
3.16 Data Collection Procedure 46
3.17 Plan for Data Analysis 46
3.18 Protection of Human Rights 47
4. ANALYSIS AND INTERPRETATION OF DATA 49
5. DISCUSSION 86
6. SUMMARY AND CONCLUSION
6.1 Summary 94
6.2 Findings of the study 97
6.3 Conclusion 99
6. 4 Implication of the study 99
6. 5 Recommendations 101
6.6 Limitations 101

REFERENCES 102

APPENDICES 107
 

 
 LIST OF TABLES
TABLE PAGE
TITLE
NO NO
Frequency and percentage distribution of samples according to
1. 50
demographic variables
Frequency and percentage distribution of pretest level of pain
2. 64
among childrenin control group
Frequency and percentage distribution of pretest level of pain
3. 65
among children in experimental group
Frequency and percentage distribution of posttest level of pain
4. 66
among children in control group
Frequency and percentage distribution of posttest level of pain
5. 67
among children in experimental group
Effectiveness of Music therapy on pain among children in
6. 68
experimental group.
Effectiveness of Music therapy on systolic pressure among
7. 69
children in experimental group.
Effectiveness of Music therapy on diastolic pressure among
8. 70
children in experimental group.
Effectiveness of Music therapy on pulse rate among children in
9. 71
experimental group.
Effectiveness of Music therapy on respiration rate among
10. 72
children in experimental group
Comparition of the post test level of pain among children in
11. 73
control group and experimental group
Comparition of the post test level of systolic blood pressure
12. 74
among children in control group and experimental group
Comparition of the post test level of diastolic blood pressure
13. 75
among children in control group and experimental group
Comparition of the post test level of pulse rate among children
14. in control group and experimental group 76
TABLE PAGE
TITLE
NO NO
Comparition of the post test level of respiration rate among
15. 77
children in control group and experimental group
Association between the post test level of pain and selected
16. demographic variables of the children in control group 3rd post 78
operative day morning .
Association between the post test level of pain and selected
17. demographic variables of the children in control group 3rd post 80
operative day evening
Association between the post test level of pain and selected
18. demographic variables of the children in experimental group 82
3rd post operative day morning
Association between the post test level of pain and selected
19. demographic variables of the children in experimental group 84
3rd post operative day evening.
 

 
 LIST OF FIGURES

1 Conceptual framework 37

2 Schematic representation of the study 48

3 Distribution of children according to age 54

4 Distribution of children according to gender 55

5 Distribution of children according to religion 56

6 Distribution of children according to place of birth 57

7 Distribution of children according to education of the child 58

8 Distribution of children according to monthly income of the family 59

9 Distribution of childrenaccording to previous hospitalisation 60

10 Distribution of childrenaccording toeducation of parents 61

11 Distribution of children according to food habit 62

12 Distribution of children according to music hearing habits 63

 

 
 LIST OF APPENDICES

APPENDIX
TITLE
NO
Letter seeking and granting permission to conduct the study

I atHead of theDepartment in Institute ofChild Health and Research

Centre, GRH, Madurai.
Ethical committee approval letter.
II
Letter seeking permission for validation of content and tool.
III

IV Content validity certificates.

V Informed consent form.

VI Research Tool – English.

VII Research Tool – Tamil.

VIII English Editing Certificate.

IX Tamil Editing Certificate.

X Intervention.

XI Training Certificate for Music therapy.

XII Photographs.
 

 
 LIST OF ABBREVIATION

MT – Music Therapy

MTPS – Music alternate engagement

PIVA - Peripheral intravenous Access

FLACC – Face, legs, activity, cry and consolability

VAS – Visual Analogue scale

WBS – Wong Baker Scale

CBM – Cognitive behaviour method

POMS – Profile of mood status

VRS - Verbal rating scale

BP - Blood pressure

HR – Heart rate

 
 
 
 
 
 

Introduction
 CHAPTER-I

INTRODUCTION

“Too often we under estimate the power of a touch, a smile, a kind word, a

listening ear, an honest compliment, or the smallest act of caring, all of which

have the potential to turn a life around.”

‐ Leo Buscaglia

Pain is a feeling of distress, suffering or agnoy, caused by stimulation of

specialized nerve endings. Its purpose is chiefly protective and induces the sufferer

to remove or withdraw from the source. The role of nurse is vital in the assessment

and management of pain experienced by children during hospitalization. Although

many disciplines are involved in pain management, nurses have the responsibility to

assess the children’s overall medical status by highlighting the children needs to

other members of the healthcare team and nurses spend more time with children

than other healthcare providers.

Pain is an “unpleasant sensory and emotional experience associated with

actual or potential tissue damage or described in terms of such damage”.

‐ international association for study of pain

Music

“Music soothes us stris up;

It puts nobles feeling in us;
It melts us to tears, we know not how”
- Charles kingsley.

Music is the tool with in music therapy used to alleviate pain perception.

Music is a human activity, which involves structured and audible sounds, which is

1 
 
used for artistic or aesthetic, entertainment or ceremonial purposes. Definitions vary

in different cultures and social milieus.

Recorded history relates stories of humankinds’ use of music to soothe the

body, mind and spirit. This corresponds with the definition of pain as an emotional

quality as recorded by Aristotle. As a movement of research toward specificity

began, research found that music has also been found to alter mood and elicit

relaxation responses and also music as a distraction is able to alter thoughts,

emotions, or mood by inducing relaxation (Magill-Levreault, 1993). Music alters

specific physiologic responses, such as heart rate and respiration rate (Lusk and

Lash, 2005).. Music is able to elicit pleasure, which is assumed to motivate (Stige,

2006). Music, as is pain, is a subjective sensory and emotional experience. Response

to music, as to pain, is based on past experience and/or present state of mind.

Music Therapy

Music therapy is the skillful use of music and musical elements by an

accredited music therapist to promote, maintain, and restore mental, physical,

emotional, and spiritual health. Music has nonverbal, creative, structural, and

emotional qualities. These are used in the therapeutic relationship to facilitate

contact, interaction, self-awwereness, learning, self-expression, communication, and

personal development.

- Canadian Association for Music Therapy.

Music Therapy is an established healthcwere profession that uses music to

address physical, emotional. cognitive, and social needs of individuals of all ages.

Music therapy improves the quality of life for persons who were well and meets the

2 
 
needs of children and adults with disabilities or illnesses. Music therapy interventions

can be designed to:

 promote wellness

 manage stress

 alleviate pain

 express feelings

 enhance memory

 improve communication

 promote physical rehabilitation

‐ American Association of Music Therapy (1970)

Pain in Children: Specific Issues

During the last decade it has been recognized that research in pediatric pain

has been a minority field and that pain in children has been highly undertreated.

Although there is an increasing amount of research on pediatric pain in the literature,

a large discrepancy remains in the proportion of adult- versus child-focused research

on pain and hospital experiences in general.

In 1977, Eland and Anderson reported that only 2.4 % of papers published in

the werea of pain dealt with pediatric pain. An analysis of the titles of articles

published in 1992 in the Journal of Pain and Symptom Management showed a more

positive picture: 7.8% of all the papers were devoted to pediatric pain. However,

when other journals were considered, the outcome was not as high. During the same

period, only 2.3 % of the papers published in Pain were related to pediatric pain

(Guardiola & Banos, 1993). An analysis of biomedical articles listed in the Medline

Database between 1981 and 1990 indicated a growing interest in pediatric pain:

3 
 
papers devoted to neonatal pain have increased fourfold and those regarding infant

pain threefold. However, increases in articles devoted to children (2-12 yr) and

adolescents (13-18 yr) were much smaller in number and were comparable to those

observed for the pain field in general (Guardiola &Banos, 1993).

Under treatment of Pediatric Pain

Many myths have led to serious under treatment of pain in children. For

instance, large discrepancies have been reported between the amount of

postoperative analgesia administered to adults and that administered to children who

have the same diagnoses and who have undergone the same medical procedures

(Walco, Cassity, & Schechter, 1997).Only recently have these myths been

discredited (Ross & Ross, 1984; Walco et al., 1997; Zajdeman & Biedermann,

1991).

Myths About Pain in Children

"Young children do not feel pain."

Until recently, health cwere professionals were convinced that young children

could not feel much pain. Underpinning this belief was the assumption that the

nervous systems of young children are immature and, therefore, less sensitive to

noxious input. Children's screams were said to stem from fear more than from pain.

It has been found, however, that at 30 weeks of gestation, pain pathways and the

parts of the brain involved in pain perception are well developed. Pain pathways to

the central nervous system, for example, are completely myelinated from the 30th

week of gestation on, allowing for a normal conduction speed in the nerves (Kuttner,

1996; Volpe,1981; Walco et al., 1997). It is also known now that the younger the

child, the lower the threshold for pain (Zajdeman & Biedermann, 1991).

4 
 
 Furthermore, a child’s level of understanding may mean that he or she is unable to

comprehend what is causing the pain. A child may, therefore, experience more pain

than an adult in a similar situation(Waycross, 1998). Despite this knowledge,

circumcisions on newborn males, for example, continue to be performed without

adequate analgesia. Several behavioral and physiological responses of distress are

apparent when infants are circumcised without analgesia, including loud screaming

and significantly elevated blood pressure, heart rate and cortisol levels. (P.A.

McGrath, 1990).

"Children have no memory of pain."

It was furthermore believed that if children did feel pain, they would not

remember it and, therefore, it would have no lasting effect. Recent studies, however,

have indicated that pain does endure in the memory of infants and children

(Walco.et.al., 1997; Zajdeman & Biedermann, 1991). Long-term memory requires

adequate functioning of the limbic system and the diencephalon, both of which are

well-developed and functional at birth (Zeltzer, Bursch, & Walco, 1997). By the age

of 6 months infants consistently avoid potentially painful stimuli; this demonstrates

infants' memory for pain by that age (P.A. McGrath, 1993).

" Children get addicted to opioid analgesics."

Many studies have found that medical and nursing staff, because of an ill-

founded fear of the effects of opioids and addiction, have been giving children and

infants significantly less opioid medication than adults for similar pain conditions

(Kuttner, 1996; P.J. McGrath & McAlpine, 1993).Pwerents have been found to

decline medication for their child's pain possibly because they fear that their child

5 
 
 will become accustomed to using drugs to solve other problems (P.J.McGrath &

McAlpine, 1993).

It is important, however, to make the distinction between physical dependence

and addiction. When analgesics are administered appropriately, the risk of addiction

is minimal. Unlike adults who take drugs for pleasure, children will not become

addicted when they take medication to combat pain. A physical dependence may

indeed develop, but a gradual reduction in the medication, after the pain has

subsided, is used to control withdrawal symptoms (Kuttner, 1996; Walco et al.,

1997).

Related to this issue is the fear that opioids could adversely affect the respiratory

abilities of children. Although this concern may be valid in some cases, there are no

dataavailable to support the notion that children are more susceptible to opioid-

related respiratory suppression than adults (Walco et al., 1997).

“ Children cannot accurately report on their pain."

Another misconception is that a child's pain cannot be assessed accurately: a

child cannot be considered as a trustworthy communicator of his or her pain.

Therefore, adults rely on their own observations rather than on the child's self-report

to assess the child's pain. Parents and healthcare professionals, however, often

misinterpret clear signs of pain in children. P.J. McGrath and McAlpine (1993)

suspect that denial on the part of the adult may be a possible factor in this

underassessment.

Several studies have indicated, however, that children from the age of five

years on are reliable reporters of their own pain experience. To explain their pain,

6 
 
younger children need to be asked where they are hurting. It is also of utmost

importance that assessment questions be asked in age-appropriate language. Adequate

pain assessment is indeed a complicated matter, but there are many good,

comprehensive pediatric pain assessment tools available which are based on

physiological measures, behavioral observations and self-reports (Finley & McGrath,

1998; P.J. McGrath & McAlpine, 1993; Varni, Walco & Katz, 1989)

"A playing child is not in pain."

A huge misconception that is still prevalent is that if a child can be distracted,

he or she is not in pain. Distracting a child from the pain indicates that the child is

able to use cognitive strategies to move away from the pain, however, distraction does

not exclude the existence of pain (Kuttner, 1996). According to McCaffery and Beebe

(1990), increased activity is often a sign of pain; it is the way children cope.

Effect of music on various organs of the body

Respiratory system.

Music balances the heart rate, and respiratory rate. Peripheral vascular flow is

increased due to vasodilatation. A variety of muscles become active while listening to

music, diaphragm, abdominal, intercostals, respiratory accessory, facial and

occasionally muscles in the arms, legs and back. Soothing music acts as a muscle

relaxant also.

Cardiac Exercise

Music is equivalent to “an internal jogging” music can provide good cardiac

conditioning. It balances the heart rate and blood pressure.

Pain Reduction

The effect of music stimulates the secretion of beta endomorphines in the

brain, thus affecting pain receptor sites on nerve cells and reducing pain sensations.

10 minutes of listening to relaxing light music has an anaesthetic effect and would

7 
 
give at least 2 hours of pain-free sleep, also decreases pain threshold. Music allows a

person to forget about pains such as aches, arthritis. Music also reduces sedimentation

rates there by reduces the inflammation in the body.

Music decreases ‘stress’ hormones

Music lowers epinephrine and dopamine level (as measures by dopac)

involved in the fight and flight’ response, and is associated with elevated blood

pressure. Music reduces at least four neuroendocrene hormones associated with stress

response. These were epinephrine, cortisone, dopamine and growth hormone. Music

is a powerful antidote to stress.

Music promotes recovery from illness

Music is a pleasurable experience; it momentarily banishes feelings of fear

and anger. It gives us a feeling of power and control. We feel cwere free, light hearted

and hopeful during the moments of listening to light music. These feeling may have

therapeutic benefits by reversing the immunosuppressive effects of the emotions of

anger, fear or loneliness which often accompany hospitalization and recovery from

illness.

Care givers can express their understanding and appreciation of the patient’s

struggle through the use of music. As nurses find ways to develop the natural

resources of music and tears into their work with patients and families, they will

experience further benefits in stress management and emotional support. Music can

create an environment where hope can flourish because it provides a sense of joy,

helps us connect with family and friends, and inspires an appreciation and gratitude

for life.

8 
 
Spiritual effect of music

Spirit can be defined as the vital essence for animating a living organism,

often considered divine in origin. Spirit can also be regarded as vivacity or energy.

Music, on all levels, therefore is something that flows, involving basic characteristics

9 
 
of the individual which express themselves in the body, in moods and emotional

reactions, and in qualities of feeling of mind and spirit. The qualities of music and

spirit are similar and inter dependent. As cwere givers we offer therapy, to facilitate

the healing processes within the body. To be most effective, we must direct our efforts

to touch the body, mind and spirit.

Resolve inter personal conflicts

Music can be effective methods of facilitating inter personal conflict

resolution. By discharging anger- and fear- generated tensions, they can create the

condition for constructive action planning.

Affect mental outlook

Music and tears have the capacity to “clear the head” and alter mental

perspective. They facilitate a transformation of feelings of helplessness and negative

expectancy into feelings of motivation to make choices and solve problems.

Music reduces anxiety

After the initial stimulation of music resulting in muscular contraction,

relaxation occurs not only in the skeletal muscles, but also in the cardiovascular

system. The efficiency of respiratory system is also increased. Muscle relaxation and

anxiety cannot exist together.

Music regulates both sexual and aggressive desires

Studies have viewed music as a regulator of both sexual and aggressive

desires. As such it is the outcome to repressed sexual and aggressive impulses pushed

into the subconscious. The jokes including music release then from the reserves of

10 
 
psyche energies and once it is delivered from the process of repression can be halted

as a safe outlet has been found.

Music releases tension

Tension accompanies painful emotions of fear, anger and sadness, listening to

music for 10 minutes is often more beneficial to and supportive of an emotionally

upset patient or family member than an hour’s lecture on proper ways of feeling and

coping. This can be an effective self-care tool.

Music relieves loneliness

Loneliness implies a longing for companionship, wish not to be alone.

Listening to music allows us to perceive and appreciate incongruities of life, and

provides moments of joy and delight.

Psychological impact of music

Music creates a more relaxed atmosphere. It can also help to reduce anxieties,

tensions, natural fears and worries by providing a safe and acceptable outlet for pent

up emotions. For depressed persons music can provide more positive frame of

reference, helping to deal with disappointments and feelings of guilt and to strengthen

self-esteem. Music also allows for objective self-analysis without risking the loss of

face. It also serves as an escape or defense mechanism that people use to avoid

anxieties.

Music and the effect on mind

Music perception involves the whole brain and serves to integrate and balance

activity in both hemispheres. Music pulls the various parts of the brain together rather

than activating a component in only one area. Music has the capacity to “clear the

11 
 
head” and alter mental perspective. Music facilitates the transformation of feelings of

helplessness and negative expectancy into feelings of motivation to make choices and

solve problems. Narrow-mindedness or tunnel vision restricts the perception of one’s

range of options. Psychosis, a “hardening of attitudes,” is a potent cause of stress

related pathology. Music can alter perspective, uncover options and help restore a

sense of motivation in the process. Relaxing music soothes the CNS.

Music reduces social and emotional distance

In healthcare settings music helps to reduce fear of the unfamiliar hospital

settings and encourages a sense of trust. Music is an effective tool when establishing

nurse-patient relationship. Music is a natural and acceptable vehicle for

communicating feelings such as embarrassment, anger and frustration. Light music

during stressful work especially ICUs, OT, labour room, OPD, wards and post

operative room etc. helps nurses to cope with their work and create a better

atmosphere in the ward. Music gives us perceptual flexibility and thus can increase

our cognitive control.

Music gives maximum relaxation:

Music soothes the central nervous system. It lowers epinephrine and dopamine

levels involved in the fight and flight response, and is associated with elevated blood

pressure. It reduces at least four neuroendocrine hormones associated with stress

response. Music effects involve the whole brain, serve to integrate and balance

actively in both hemispheres.

12 
 
Music improves communication:

Music helps to improve communication in 3 ways:

• It captures the attention of the learner.

• It enhances the retention of the material.

• It helps release the tension that blocks communication.

Music helps to reduce social and emotional distance. Music is a natural and an

acceptable vehicle for communicating feelings such as embarrassment, and

frustration. Nurses should encourage its use.

1.1.NEED FOR THE STUDY

“Pain is such an uncomfortable feeling that even a tiny amount of it is enough to

ruin every enjoyment”
- William Rogers

Pain is the more terrible lord of mankind than even death itself today. Pain has

become the universal disorder, a serious and costly public health issue, and a

challenge for he family friends, and healthcare providers who must give support of

the individual suffering from physical as well as the emotional consequences of pain.

Nurses are primarily responsible for providing pain relief in the healthcare

area. So by participating in research projects nurses become leaders in their own

departments by working to improve nursing practice and patient care. The nursing

researcher will mentor a clinical nurse through data collection, analysis and through

the publication process. Once published the nurses have the opportunity to present

their findings at national meetings there by influencing patient care and nursing

practice at a national level. Research provides opportunity to further gain knowledge

and recognition.

13 
 
 A cross sectional survey was conducted in the USA among 170 children

recovering from surgery in two major teaching hospitals along with an analysis of

analgecs medication prescribed and administered. Analgesic medication was not

ordered for 16% of the patient and narcotic analgesic medication ordered was not

given for 39% of the patients. In 29% of the patients, where an order for ―narcotic

or non-narcotic analgesic medication‘ was written, the non-narcotic drug was given

exclusively. The result showed that irrespective of the treatments received, only 25%

of the patients were pain free on the day of surgery and 13% reported severe pain. By

the first postoperative day, 53% reported no pain but 17 still reported severe pain and

the research concluded that there is considerable scope to improve pain management

in children after surgery. This improvement must be based on improved education of

medical and nursing staff in contemporary clinical pharmacology and non

pharmacological methods.( National health survey)

Several studies from North America indicate that nurses underestimate the

amount of pain experienced by children. The issue was examined by comparing the

pain ratings of 100 children 3–15 years of age following tonsillectomy. The ratings

were obtained by using the poker chip tool and a 10-cm visual analogue scale. In

general, nurses underestimated the children's pain. The nurses tended to overestimate

the effect of analgesics. Although the correlations between the children's and the

nurses' pain scores were statistically significant the findings indicate that the nurses

are not good at interpreting the patients' pain.( Danish children and nurses

association).

In india Many studies demonstrate inadequate pain treatment in children. The

aim of this nation wide survey was to evaluate the prevalence of acute and

14 
 
 postoperative pain in children; extent of, and reasons for, inadequate pain therapy;

therapy methods; pain-management structure; and the need for education of

healthcare professionals. The response rate was 75% (299/395). Answers from

physicians and nurses showed that, despite treatment, moderate to severe pain

occurred in 23% of patients with postoperative pain and 31% of patients with pain of

other origin. Postoperative pain seemed to be a greater problem in units where

children were treated along with adults and in departments where fewer children

were treated.

According to a post operative pain management survey conducted among

nurses, only 4 out of 177 nurses used non-drug pain management to assist patients

with pain (Wessman & McDonand, 1999). There is certainly room for all nurses and

nursing students to invest more time into learning about alternative post operative

pain management methods. Methods with strong research backing their efficacy in

children (Tracey et al., 2006) are massage, music, guided Imagery, distraction and

patient education.

Diversion as a post operative pain management tool encompasses a host of

possible interventions. This includes music, guided imagery, game playing, and

watching TV. One nurse involved in pediatric pain studies found that the use of

distraction was so effective that the research became contaminated by caregivers

using it more frequently than called for in the study (Stubenrauch, 2007).

Children‘s are easily diverted. This may explain the mistaken belief dating

back to the 60′s that child didn‘t experience pain in the same way as adults and

therefore didn‘t need aggressive pain management (Swafford & Allen, 1968). That

15 
 
 children can be temporarily distracted from their pain doesn‘t mean that they don‘t

experience pain or that the pain doesn‘t return once the diversion is removed.

Diversion has varying levels of effectiveness depending on the patient. It does

have the benefit that it can be utilized by every member of the pediatric patient‘s care

team, including the patient herself. In fact, providing the patient with a choice of

distractions may allow for the most effective distraction to be chosen.

At Institute of Child Health and Research Centre, Government Rajaji

Hospital, Madurai, an average of 900-1000 children irrespective of age are admitted

in the pediatric medical and surgical ward. In approximately per year 585 children

were undergone surgery, 90% of them require a analgesic to reduce post operative

pain. The present study proposes to determine the effectiveness of music therapy on

pain among the children undergone surgeries.

1.2.STATEMENT OF THE PROBLEM

A study to assess the effectiveness of music therapy on pain among children

undergone surgical procedures in Institute of Child Health and Research Centre at

Government Rajaji Hospital Madurai.

1.3. OBJECTIVES OF THE STUDY

1. To assess the level of pain among children undergone surgical procedures in

experimental group and control group.

2. To evaluate the effectiveness of music therapy on pain among children undergone

surgical procedures in experimental group.

3. To compare the post test level of pain among children undergone surgical

procedures in experimental group and control group.

16 
 
4. To associate the level of pain among children undergone surgical procedures with

selected demographic variables in both groups.

1.4 HYPOTHESES

H1: There is a significant difference between the level of pain among children

undergone surgical procedures, of experimental group after music therapy.

H2: There is a significant difference in the post test level of pain among children

undergone surgical procedures in experimental group and control group.

H3: There is a significant association in the level of pain among children

undergone surgical procedures with selected demographic variables in both

groups.

1.5.OPERATIONAL DEFINITIONS:`

 Effectiveness

In this study refers to effectiveness is intended outcome of the music therapy

on pain among children undergone surgical procedures, which was measured through

visual analog scale.

 Music therapy

In this study refers to music therapy is a rhythmic and melodious tune of

selected Indian classical music recorded in a cell phone and administer through the

head phone, for 15-20 mins twice a day in second and third post operative day to

divert the attention from pain perception.

 Pain

In this study refers to pain is a unpleasant feeling or discomfort felt by

children undergone surgical procedures, which is measured by visual analogue scale

17 
 
 and also monitored the physiological parameters (pulse, respiration, and blood

pressure).

 Children 6-12years

In this study refer to Children between 6-12 years of age undergone surgical

procedures, admitted in post operative ward.

 Surgical procedure

In this study refer to the surgical procedure refers to major abdominal

surgeries.

1.6 VARIABLES

Independent variable - music therapy

Dependent variable - pain

1.7 ASSUMPTIONS

The study assumes that:

 Children who are undergone surgical procedures were susceptible to develope

post operative pain.

 Music therapy may not induced any adverse reaction to the children.

1.8 DELIMITATIONS

The study is delimited to:

 The sample size was limited to 60.

 The data collection period was limited to 6 weeks

 The study is limited to the post operative children (6 -12 years) who have

undergone major abdominal surgery.

18 
 
1.9 PROJECTED OUTCOME

The findings of the study can help the investigator to assess the effectiveness

of music therapy in reducing the level of pain among children undergone major

abdominal surgery.

19 
 
Review of Literature
 CHAPTER - II

REVIEW OF LITERATURE

Review of literature is a key step in research process. The literature review is

to discover what has previously been done about the problem to be studied what

remains to be done, what methods have been employed in other research and how the

result of other research in the area can be combined to develop knowledge.

It is essential step; it can be done before and after selecting the problem. It can

help to determine what is already known about the topic (A.P.Jai, 2005)

.
This chapter deals with two parts:

Section -A: Review of literature related to studies.

Section-B: Conceptual framework based on Modified Imogene King’s Goal

Attainment Theory (1981)

This chapter attempts to present a review of studies done methodology

adopted and conclusion attained by earlier investigators which helps in this study.

The sources are internet search, textbook, published journal, editorials published and

unpublished thesis.

SECTION - A

In this chapter, the researcher presents the review of the literature under the

following headings

2.1 Literature related to pain among children undergone surgical procedures.

2.2 Literature related to Non pharmacological management of postoperative

pain in children.

20 
 
2.3 Literature related to effects of music therapy in children.

2.4 Literature related to effects of music therapy on pain among children

undergone surgical procedures.

2.1. LITERATURE RELATED TO PAIN AMONG CHILDREN UNDERGONE

SURGICAL PROCEDURES.

Deborah Tomlinson, M (2009) A prospective descriptive correlational study

to compare the Faces pain scale and analogue scale in AIIMS, New Delhi among

children aged 6 to 12 years undergoing selected procedures.The objective of the study

is to compare the procedural pain in child as perceived by the child , parents and

health professionals.181 samples were selected by simple random sampling

technique.The results revealed that there was a significant positive correlation (r> 0.8)

between both the pain scales.The study concluded that Faces pain scale and Analogue

scale are appropriate instruments for measuring pain intensity among Indian children

aged 6 to 12 years undergoing selected procedures.

Lillian Sung, PhD (2008) A retrospective study to determine if there is

regular assessment of children’s pain ,pain management and postoperative progress at

Cariboo,Canada.Children aged 5 to 17 years (n=36) measured their pain every four

hours post operatively using the Wong-Baker Faces Pain Rating scale. Outcomes

regarding amount of analgesic given , subjective pain reports , and progress of

ambulation were compared with a control group.The study results revealed that

despite all children having prescribed analgesic orders, one quarter of the children

received no pain relief intervention .Also , one quarter of the children stated that their

pain control was only partially effective.The study concluded that there is ineffective

21 
 
pain management in children and highlights a need for improved nursing practice , in

terms of increased awareness of pediatric pain management practice.

2.2.LITERATURE RELATED TO NON PHARMACOLOGICAL

MANAGEMENT OF POSTOPERATIVE PAIN IN CHILDREN

Ewa Idvall.et.al, (2009) did a study on Pain experiences and non-

pharmacological strategies for pain management after tonsillectomy: a qualitative

interview study of children and parents Tonsillectomy is one of the most common

pediatric surgical procedures. This study aimed to investigate children’s experience

of pain and the non-pharmacological strategies that they used to manage pain after

tonsillectomy. A further aim was to investigate parental views on these same

phenomena. Six children (aged seven to 18 years) and their parents (four mothers

and two fathers) were interviewed separately on the day after tonsillectomy. The data

were analyzed using a qualitative approach. Pain experiences were divided into the

categories of physiological pain and psychological pain. Children rated their ‘worst

pain’ during the past 24 hours between 6 and 10 (visual analogue scale, 0-10). The

non-pharmacological strategies used most frequently to manage pain were thermal

regulation (physical method) and distraction (cognitive-behavioural method)

according to the framework used. Specific non-pharmacological strategies for pain

management relative to different surgical procedures need to be considered.

Päivi Kankkunen M.Sc RN,(2003) Pwerents' use of nonpharmacological

methods to alleviate children's postoperative pain at home .Nonpharmacological

methods are stated to be effective in alleviating children's postoperative pain when

used as an adjuvant to analgesics. However, little is known about how these methods

are used by parents at home. The purpose of this study was to describe parents' use of

22 
 
 nonpharmacological methods at home in 1–6-year-old children's pain alleviation

after minor day surgery. Mothers ( n = 201) and fathers (n = 114) whose child had

undergone day surgery in 10 Finnish hospitals between October 2000 and September

2001 filled in a questionnaire including a Visual Analogue Scale, Parents'

Postoperative Pain Measure and a subscale consisting of 25 items measuring parents'

use of several nonpharmacological pain alleviation methods with their children at

home after day surgery. The most frequently used nonpharmacological pain

alleviation methods were holding the child on the parent's lap, comforting the child

and spending more time with them. Differences were found in mothers' and fathers'

use of these methods. In addition, several methods were used more with girls than

with boys. Significant relationships were found between parents' use of

nonpharmacological pain alleviation methods and children's pain intensity and pain

behavior.

Hong-Gu He M.Sc MD.et.al (2005) Chinese nurses’ use of non-

pharmacological methods in children's postoperative pain relief. This paper reports a

study describing Chinese nurses’ use of non-pharmacological methods for relieving

6- to 12-year-old children's postoperative pain and factors related to this. A

questionnaire survey was carried out in 2002 with a convenience sample of 187

nurses working at 12 surgical wards in five hospitals of Fujian Province, China. A

Likert-type instrument was used, and the average response rate was 98%. Descriptive

statistics and content analysis were used to analyze the data. The most commonly

used non-pharmacological methods were giving preparatory information,

comforting/ reassurance, creating a comfortable environment, distraction, and

positioning. Positive reinforcement and helping with daily activities were used less

often, and transcutaneous electrical nerve stimulation was not used at all. Many nurse

23 
 
 background factors were statistically significantly related to their use of pain

alleviation methods. Furthermore, many factors limited their use of non-

pharmacological methods, the most common being that there were too few nurses for

the work that had to be done, followed by nurses’ lack of knowledge about pain

management.

Katri Vehviläinen-Julkunen.et.al, (2002) did a study on Parents' roles in

using non-pharmacological methods in their child's postoperative pain alleviation

Increasingly nowadays, parents participate more fully in the care of their hospitalized

children. The purpose of this study was to describe parents' utilization of selected

non-pharmacological methods in relieving their hospitalized child's (aged 8–

12 years) postoperative pain, and factors related to this function. •Data were

collected by a questionnaire survey completed by parents ( •n=192) with a child

hospitalized on a pediatric surgical ward in the five university hospitals of Finland.

The response rate was 90%.Results indicated that non-pharmacological methods,

such as emotional support and helping with daily activities, were well utilized where

as cognitive-behavioural and physical methods were less frequently used strategies.

Certain background factors specific to the parents and their hospitalized children

were significantly related to the non-pharmacological methods used by the parents.

The hospitalized child's gender, the time of the surgical procedure, and the parents'

assessments of their child's pain intensity, were especially significantly related to

many of these strategies. •The findings of this study could be used in clinical

practice to improve guidance provided to parents regarding interventions for

children's pain relief.

24 
 
 Tarja Pölkki MNSc RN, (2001) conducted a study on Nonpharmacological

methods in relieving children’s postoperative pain: a survey on hospital nurses in

Finland. The aim of this study was to describe nurses’ use of selected

nonpharmacological methods in relieving 8–12-year-old children’s postoperative

pain in hospital. The convenience sample consisted of 162 nurses working on the

pediatric surgical wards in the five Finnish university hospitals. An extensive

questionnaire, including a five-point Likert-scale, on the nurses’ use of selected

nonpharmacological methods and demographic data was used as a method of data

collection. The response rate was 99%. Descriptive statistics as well as

nonparametric Kruskall–Wallis anova and the chi-squwered test were used as

statistical methods. The study indicates that emotional support, helping with daily

activities and creating a comfortable environment were reported to be used routinely,

whereas the cognitive-behavioural and physical methods included some less

frequently used and less well known strategies. The results also show that attributes,

such as the nurses’ age, education, and work experience, the number of children the

nurses had, the nurses’ experiences of hospitalization of their children as well as the

hospital and the place of work, were significantly related to the use of some

nonpharmacological methods.

2.3.LITERATURE RELATED TO EFFECTS OF MUSIC THERAPY IN

CHILDREN

Anurani A. Augustine.et.al.,(2013) did a study on effect of music therapy in

reducing invasive procedural pain- a quasi experimental study Illness and

hospitalization expose children to unfamiliar and unpleasant feelings. Pain is a

physiological and psychological experience that children encounter during

hospitalization. Quasi experimental post tests only design was adopted. 80 children

25 
 
 aged 3-7 years who underwent invasive procedures were selected using convenience

sampling technique and randomly assigned to experimental (n=40) and control

(n=40) groups. Data was collected using FLACC Behavioral pain assessment scale.

The mean pain score of children in experimental group (3.88) was lower than control

group (8.15). The independent ‘t’ value (t=15.448) computed between experimental

and control group was statistically significant at p<0.05. Children consider, needle

procedure is the most distressing experiences of medical-related care. Music has the

potential to decrease the need for pharmacotherapy. Music can distract the child and

decrease the pain perception.

Ilan Sanfi (2010) did a study on The Effects of Music Therapy as Procedural

Support on Distress, Anxiety, and Pain in Young Children under Peripheral

Intravenous Access: Randomized Controlled Trial 41 children (1 to 10 years) were

enrolled and underwent a single PIVA procedure. The children were randomly

assigned to either an MT or a comparable control group receiving PIVA. In addition,

the music therapy (MT) group received individualized MTPS (i.e. music alternate

engagement) before, during, and after PIVA. The intervention was performed by a

trained music therapist and comprised preferred songs, improvised songs/music, and

instrument playing. The study was carried out in accordance with the rules in force

regarding research ethics and clinical MT practice. The study examined the effect of

MT in relation to 16 outcome measures comprising these outcome domains: Distress,

Anxiety, Pain intensity, overall satisfaction with PIVA, Compliance, Number of

needle pricks, Duration of the PIVA procedure, and Satisfaction with the applied

MTPS intervention. In short, self-report, observational data, and count data were

used. From an overall perspective, the results of the study were in favour of the MT

group, except for pwerent-rated Child Pain, which was slightly higher in the MT

26 
 
 group. In addition, similar mean scores were found in the two groups for Parent

Compliance. The results showed that a single MTPS session was highly significantly

effective in reducing the Duration of the PIVA procedure (33%). The MT

intervention was also significantly effective in reducing Child Anxiety. Trends

towards significance were also found for child Anxiety, Pain, and Compliance.

Results suggested that MTPS may be effective in reducing the Number of needle

pricks. No significant result was found for Overall satisfaction with PIVA.

Furthermore, the majority of the participants found the MT intervention beneficial.

Finally, after removal of an outlier, the overall picture became more distinct and two

additional significant results were found.

Christian Gold.et.al (2004) did a study on effects of music therapy for

children and adolescents with psychopathology: a meta-analysis. The objectives of

this review were to examine the overall efficacy of music therapy for children and

adolescents with psychopathology, and to examine how the size of the effect of

music therapy is influenced by the type of pathology, client's age, music therapy

approach, and type of outcome. Eleven studies were included for analysis, which

resulted in a total of 188 subjects for the meta-analysis. Effect sizes from these

studies were combined, with weighting for sample size, and their distribution was

examined. After exclusion of an extreme positive outlying value, the analysis

revealed that music therapy has a medium to large positive effect (ES = .61) on

clinically relevant outcomes that was statistically highly significant (p < .001) and

statistically homogeneous. No evidence of a publication bias was identified. Effects

tended to be greater for behavioural and developmental disorders than for emotional

disorders; greater for eclectic, psychodynamic, and humanistic approaches than for

27 
 
 behavioural models; and greater for behavioural and developmental outcomes than

for social skills and self-concept.

Dianna T. Kenny.et.al., (2004) was conducted a study on The Impact of

Group Singing on Mood, Coping, and Perceived Pain in Chronic Pain Patients

Attending a Multidisciplinary Pain Clinic This study explored the impact of group

singing on mood, coping, and perceived pain in chronic pain patients attending a

multidisciplinary pain clinic. Singers participated in nine 30-minute sessions of small

group singing, while comparisons listened to music while exercising. A short form of

The Profile of Mood States (POMS) was administered before and after selected

singing sessions to assess whether singing produced short-term elevations in mood.

Results indicated that pre to post difference scores were significantly different

between singing and control groups for only one of the 15 mood variables (i.e.,

uneasy). To test the longer term impacts of singing the Profile of Mood States, Zung

Depression Inventory, Pain Self-Efficacy Questionnaire, Pain Rating Self-Statement,

and Pain Disability Questionnaire were administered immediately before and after

the singing sessions. All inventories other than the POMS were re-administered 6

months later. One-way ANCOVAs indicated that participants who attended the

singing sessions showed evidence of post intervention improvements in active

coping, relative to those who failed to attend, when pre intervention differences in

active coping were controlled for. While the singing group showed marked

improvements from pre to post intervention on all moods, coping, and perceived pain

variables, these improvements were also observed among comparison participants.

The results of this study suggest that active singing may have some benefits, in terms

of enhancing active coping, though the limitations of the study and small effect sizes

observed suggest that further research is required to fully explore such effects.

28 
 
 Caprilli, Simona.et.al., (2007) Interactive Music as a Treatment for Pain and

Stress in Children during Venipuncture: A Randomized Prospective Study The

sample population was composed of 108 unpremeditated children (4–13 years of

age) undergoing blood tests. They were randomly assigned to a music group (n =

54), in which the child underwent the procedure while interacting with the musicians

in the presence of a pwerent or to a control group (n = 54), in which only the parent

provided support to the child during the procedure. The distress experienced by the

child before, during and after the blood test was assessed with the Amended Form of

the Observation Scale of Behavioral Distress, and pain experience with FACES scale

(Wong Baker Scale) only after the venipuncture. Results show that distress and pain

intensity was significantly lower (p < .001; p < .05) in the music group compared

with the control group before, during, and after blood sampling.

Snyder.et.al, (1999) did a study on Nurses have used music as an intervention for

many years. A sizeable number of investigations to determine the efficacy of music

in managing pain, in decreasing anxiety and aggressive behaviors, and in improving

performance and well-being have been conducted by nurses and other health

professionals. Nursing and non-nursing research reports published between the years

1980–1997 were reviewed. Great variation existed in the type of musical selection

used, the dose of the intervention (number of sessions and length exposure), the

populations studied, and the methodologies used. Overall, music was found to be

effective in producing positive outcomes.

29 
 
 2.4. LITERATURE RELATED TO EFFECTS OF MUSIC THERAPY ON

PAIN AMONG CHILDREN UNDERGONE SURGICAL PROCEDURES.

Stefan Nilsson, (2010) a study was on conducted on procedural and

postoperative pain management in children. The overall purpose of this thesis was to

investigate procedural and postoperative pain management among children in

hospital. The specific aims were to describe a group of children’s experiences of pain

in conjunction with procedural pain to validate an observational behavioural scale

for procedural pain assessment in children aged 5-16 years to study pain intensity

and distress among children using serious games and music medicine to describe

children’s experiences of the use of serious games and music medicine Two hundred

and twelve children who underwent a medical or surgical procedure at the Queen

Silvia Children’s hospital in Gothenburg participated in one or two studies, and data

were collected with assessment scales, vital signs and interviews. All the data were

analyzed using approved methods of analysis. The results showed that the children

emphasized nurses who were clinically competent and that they wanted to participate

in decision making concerning distraction techniques as a complement to

pharmacological treatment. An observational assessment scale, the Face, Legs,

Activity, Cry and Consolability (FLACC) scale, was a valuable tool for assessing

procedural pain and complementing retrospective self-reported pain and distress.

Distraction techniques were helpful coping strategies for the children, who also

needed to feel secure in the pain management. In children undergoing needle related

procedures, serious games reduced pain intensity, but only for those who liked the

game, and the interviews showed increased wellbeing. Music medicine reduced

morphine consumption and decreased the children’s distress when they underwent

day surgery.

30 
 
 Sigma Theta Tau , (2009) conducted a study to assess and compare the effect

of music therapy on postoperative pain of patient undergone elective abdominal

surgery. A quasi-experimental design was used and convenient samples of 30 (15 in

each exp & control group). Pain was measured by Verbal Rating Scale. Music

therapy was given as per patient’s wish to experimental group and intensity of pain

was monitored before and immediately after recovery from anesthesia, during the 1st

and 2nd postoperative day for both the groups. Results revealed that those patients

who listened to self selected music tapes had significant differences (p<0.001) in

pain scores when compared to the control group. The conclusion of study shows that

the music is an effective anxiolitic (relaxing agent) which can be beneficial for the

early recovery of surgical patients.

Sendelbach, Sue.E.et.al., (2006) did a study on effects of Music Therapy on

Physiological and Psychological Outcomes for Patients Undergoing Cardiac Surgery

An experimental design was used. A total sample of 86 patients (69.8% males) were

randomized to 1 of 2 groups; 50 patients received 20 minutes of music (intervention),

whereas 36 patients had 20 minutes of rest in bed (control). Anxiety, pain,

physiologic parameters, and opioid consumption were measured before and after the

20-minute period. A significant reduction in anxiety (P ≤ .001) and pain (P = .009)

was demonstrated in the group that received music compared with the control group,

but no difference was observed in systolic blood pressure (P = .17), diastolic blood

pressure (P = .11), or heart rate (P = .76). There was no reduction in opioid usage in

the 2 groups.

Thamine P.Hatem.et.al., (2006) The therapeutic effects of music in children

following cardiac surgery Randomized clinical trial with placebo, assessing 84

31 
 
 children, aged 1 day to 16 years, during the first 24 hours of the postoperative period,

given a 30 minute music therapy session with classical music and observed at the

start and end of the session, recording heart rate, blood pressure, mean blood

pressure, respiratory rate, temperature and oxygen saturation, plus a facial pain score.

Statistical significance was set at 5%. Five of the initial 84 patients (5.9%) refused to

participate. The most common type of heart disease was acyanotic congenital with

left-right shunt (41% of cases: 44.4% of controls). Statistically significant differences

were observed between the two groups after the intervention in the subjective facial

pain scale and the objective parameters heart rate and respiratory rate (p < 0.001,

p = 0.04 and p = 0.02, respectively).

Tse MM.Chan Me. Benzie, (2005) conducted a study to find the

effectiveness of music therapy on postoperative pain and analgesic use following

nasal surgery. Sample size was 57 patients (24females&33 males) who were matched

for age and sex and then non-selectively assigned to either an experimental or a

control group. Music was played intermittently to members of the experimental

group during the first 24hrs postoperative period and pain intensity was measured by

Verbal Rating Scales. It shows the significant decrease in pain intensity over time

were found in the experimental group compared to the control group (p<0.0001). In

addition, the experimental group had a lower systolic BP and HR and took fewer oral

analgesics for pain. These finding concluded that music therapy is an effective non-

pharmacological approach for postoperative pain.

Nilsson, Unosson and Rawal, (2005) conducted a study on Stress reduction

and analgesia in patients exposed to calming music postoperatively. The randomized

controlled trial was designed to evaluate the effectiveness of music therapy. Seventy-

32 
 
 five patients undergoing hernia repair in day care surgery were allocated to three

groups: intraoperative music, postoperative music and silence (control group).

Patient’s postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and

oxygen saturation were studied. The postoperative music group had less anxiety and

pain and required less morphine after 1hr compared with the control group. The

result concluded that intraoperative music may decrease postoperative pain, and that

postoperative music therapy may reduce anxiety, pain and morphine consumption.

Joke Bradt (2001) was conducted a study on the effects of music entrainment

on postoperative pain perception in pediatric patients. The purpose of this study was

to examine the effects of music entrainment, an improvisational music therapy

intervention, on postoperative pain perception in pediatric patients. Since pain

perception is influenced by emotional state and perceived level of control, the effects

of music entrainment on these variables were also evaluated. Thirty-two recovering

orthopedic patients, ages 8 to 19, participated in two music entrainment conditions

and one control condition over two consecutive days. These three conditions were

sequenced according to a Latin Squwere design to control for order and time as

confounding variables. During the music entrainment condition, live music was

created by the music therapist to match the child’s pain. Once resonance was

achieved between the pain and the music, the music slowly progressed into music

predetermined iv by the child as healing. During the control condition, daily routine

activities continued as usual. However, the subject was asked not to listen to any

music during this time. Measurements of the dependent variables were taken just

prior to and immediately following each condition by means of a pain questionnaire.

The results of the present study overwhelmingly support the effectiveness of music

entrainment as a postoperative pain management technique for children. Large

33 
 
 decreases in pain intensity (p = .000) were found for both music entrainment

sessions. In contrast, a small increase in pain, although insignificant (p = .144), was

identified for the control condition. The pain-reducing effects of the music

entrainment session were the largest as long as the music was present, and decreased

after the music had stopped. Furthermore, data indicated that music entrainment was

effective in enhancing the patients’ mood (p =.000): the children showed

significantly higher levels of happiness, peacefulness, relaxation, comfort and

calmness during both sessions. Finally, results suggested that music entrainment

moderately increased patients’ perceived level of control during the first session

(p = .014) as well as the second session (p = .005), but not during the control

condition (p = .573).

34 
 
 SECTION - B

CONCEPTUAL FRAMEWORK

The investigator adopted Modified Imogene King’s Goal Attainment Theory

(1981) based on the personal & interpersonal systems including interaction,

perception, judgement, Communication and transaction. The investigator adopted

goal attainment as a basic theory for conceptual framework, which is aimed at

effectiveness of music therapy on level of post operative pain. This involves

interaction between the researcher and the children.

Six major concepts describe these phenomena:

Perception

It refers to people’s representation of reality. Here the elderly perceived the

need of music therapy on level of post operative pain..

Judgment

Judgment is decision which is made. Here the researcher decides to provide

music therapy to reduce the level of postoperative pain and children siding decided to

participate in the research study.

Action

This refers to the changes that have to be achieved. The researcher action is to

provide music therapy to reduce the level of pain and then children decided to receive

the music therapy.

Reaction

Reaction helps in setting a mutual goal. In this study the researcher and

children set a mutual goal. Here the mutual goal is reduction in level of pain.

35 
 
Interaction

If refers to the verbal and non verbal communication between one individual

or between two or more individual who involve goal directed perception. Here the

researcher encourages the postoperative children to receive the music therapy to

reduce the level of pain.

Transaction

This is the achievement of a goal. Here the researchers goal is achievement of

the reduction in level of pain and evaluate the effectiveness of music therapy by using

visual analog scale.

36 
 
 Perception:  perceived 
the  need  for  music 
therapy for reducing  Goal Attained 
postoperative pain  Reduction in the 
Level of pain.  

Reaction 
Judgment: Decision  Action:  Assess the 
Investigator  
made to provide  Visual analog  level of pain 
music therapy for  scale  among 
pain    children (6‐ Interaction:  
12yrs)  Transaction 
Administration  of 
  Post test difference 
music  therapy  in the level of 
15‐20  mins  postoperative pain 
Experimental  twice a day for  after Music 
group  Reaction 
Judgment: Children  Responding to  2nd  and  3rd  therapy 
  Readiness to 
decide to  receive  Pre test and  postoperative 
participate in the  routine  interventio
Post  care and 
operati d
ve  Transaction 
children    Post test difference 
Perception:  Perceived  Control  Reaction  in the level of 
the  level  of  post  group   Responding to  post operative 
operative  pain  and  Routine care  Pre test 
need  for  music   
therapy 
Goal not attained 
No reduction in the 
Feed back  level of pain 

37 
 
Methodology
 CHAPTER-III

METHODOLOGY

The methodology of research indicates the general pattern of organizing the

procedure of gathering valid and reliable data for an investigation (Kothari C.R..,

2004). This chapter provides a brief description of the methods adopted by the

investigator in the study. It includes the research approach, research design, the

setting, sample and sampling technique .It further deals with the development of the

tool and procedure for data collection and plan for data analysis

This chapter deals with the description of methodology and different steps that

are taken for gathering and organizing data for the investigator to assess the

effectiveness of music therapy on pain among children undergone surgical

procedures.

3.1. RESEARCH APPROACH

The research approach tells the researcher from where the data is to be

collected, what to collect, how to collect and how to analyze them. It also suggests a

possible conclusion and helps the researchers in answering specific research

questions in an accurate and efficient way.

According to Polit and Hungler (1999) evaluative research is an applied

format research that involves finding out how well a program, practice, procedure or

policy is working. It involves the collection and analysis of information relating to

the functioning of a program or procedure. With the aim of assessing its

effectiveness.

38 
 
 The research approach adopted for this study is an quantitative (evaluative)

approach. This study aims at assessing the effectiveness of music therapy on pain

among children undergone surgical procedures

3.2. RESEARCH DESIGN

According to Kothari .C.R. (2003) “A research design is defined as the overall

plan for collecting and analyzing data, including a specification for enhancing the

internal and external validity of the study”

A research design incorporates the most important methodological decisions

that an investigator makes in conducting the research study. It depicts the overall

plan for the organization of scientific investigations. It helps the researcher in the

selection of samples, manipulation of independent variable and observation of a type

of statistical method to be used to interpret the data. The selection of design depends

upon the purpose of the study, research approach and variables to be studied.

The research design used for this study is True Expremental Design -Pretest

Post test control group design was selected to assess the level pain among children.

GROUP Pre Test Intervention Post Test

Experimental Group 01 X 02
Randomization

Control group 01 ____ 02

(R)

Schematic representation of research design

01 – Pretest assessment of expremental group and control group.
X- Music Therapy.
02- Post Test assessment of expremental group and control group.

39 
 
 R- Randomization

3.3. VARIABLES

The variable is “an attribute of a person or object that varies, that is taken a

different values”

- Polite and hunger

Independent variable

The independent variable is the variable that stands alive and is not dependant

on another. It is the cause for an action.

In the present study, the independent variable is the Music therapy.

Dependent variables

Dependent variable is the effect of the action of the independent variable and

cannot exist by itself.

In the present study, the dependant variable is pain.

3.4. SETTING OF THE STUDY

The setting is the physical location and condition in which data collection

takes place in the study. (Polit and Hungler, 1995).

The study was conducted in the post operative Ward in Institute of Child

Health and Research Centre, at GRH, Madurai.

3.5. STUDY POPULATION

The population is defined as the entire aggregation of cases that meet a

designed criterion.

40 
 
 The target population of the present study comprises of children undergone

surgical procedures.

The Accessible population of the present study comprises of children

undergone surgical procedures in post operative ward, in Institute of Child Health

and Research Centre, at GRH, Madurai .

3.6. SAMPLE

The sample is a subset of the population selected to participate in a research

study.

Polit and Hungler (1995)

The sample of the present study comprises of children those who are under

gone surgical procedures in post operative ward, in Institute of Child health and

research centre, Madurai, and who fulfilled the inclusion criteria.

3.7 SAMPLE SIZE

The sample size for the present study is composed of 60 post operative

children (30 Experimental group and 30 Control Group) who is admitted in Institute

of Child Health and Research Centre, at GRH, Madurai.

3.8. SAMPLING TECHNIQUE

Sampling is the process of selecting a portion of the population to represent

the entire population. who met the inclusion criteria.

The sample were selected those who met the inclusion criteria, and

Probability- simple random sampling technique (lottery method).

41 
 
 3.9. CRITERIA FOR SELECTION OF SAMPLES

The study include that

Inclusion criteria

 Children in the age group of 6 to 12 years

 Children who are undergone surgical procedures in major abdominal surgery

 Children who were on second post operative day.

 Children who can understand and able to speak Tamil

Exclusion Criteia

 Children who were mentally challenged

 Children those who were not able to hear.

 Children who were not willing to participate.

3.10. DESCRIPTION OF THE TOOL

 Data collection tools are the procedures or instruments used by the researcher to

observe or measure key variables in the research problem. Visual Analogue scale

was selected to assess the level of post operative pain among children. It was

considered to be the most appropriate instrument to elicit the response from

subjects who are able to understand Tamil.

 The following steps were carried out in the preparation of the tool.

1) Literature review

2) Conceptual framework

3) Discussion with experts

4) Preparation of blue print

The tool was organized into two sections. They were

42 
 
Section –A: Deals with demographic variables.

Section A consist of demographic variables of age, sex, religion, place of birth,

education of the child, monthly income of the family, previous hospitalization,

education of the pwerent, food habits, music hearing habits.

Section B: Visual Analog Scale.

Visual analog scale is a patient report scale which consists of 10 items to rate pain

responses of post operative children 6-12 year. Each item is rated on a four point

scale, scoring from 0 to 10.

3.11.SCORING PROCEDURE

The scoring system is divided into following categories

0 – Normal

01 to 03 – Mild

04 to 06 – Moderate

07 to 10 – Severe

The scoring of each item of Visual analog Scale as follows

ITEMS SCORE

Normal 0

Mild pain 1-3

Moderate pain 4-6

Severe pain 7-10

This instrument consist of 10 items. Decrease of score denotes no pain of children

towards surgical procedures.

43 
 
3.12. TESTING OF THE TOOLS

Validity of the Tool

“Validity is the degree to which an instrument measures what is intended to

measure” (Polit and Hungler. 1995).

The content of the tool was validated by the experts in the field of medicine

and Nursing. The suggestions of the experts were incorporated in the study. Minimal

modification was made in the section A & Section B of the tool. After the change the

tool was finalized. The refined modified tool was used for data collection and content

validity was obtained.

Reliability of the Tool

The accuracy and consistency of the research tool are called reliability

.Reliability of the tool was assessed by using Inter rater method. Pain score reliability

correlation coefficient value is 0.83. This correlation coefficient is very high and it is

a good tool for assessing effectiveness music therapy among children undergone

surgical procedures regarding pain management.

3.13. PILOT STUDY

A pilot study is a small scale version or a trial run for the major study. The

function of this pilot study was to obtain information for improving the project or for

assessing its feasibility.

The pilot study was conducted after getting formal administrative permission

and ethical clearance. The pilot study was conducted in the ward at Institute of Child

Health and research, Madurai. for the period of one week. Formal permission was

obtained from the Director of Institute of Child Health and research, and from the

44 
 
 Head of the Department of surgery.The pilot study was contected on 01-08-2014 to

07-08-2014. Ten samples those who fulfilled the inclusion criteria were chosen by

using Probality simple random sampling technique. Informed consent was obtained

from the mothers of the sample and data was collected. The instrument was found

reliable for proceeding with the main study. The other opinion and suggestion were

incorporated in the main study to accomplish the objectives of the study.

3.14. MUSIC THERAPY AS AN INTERVENTION TOOL

“Music therapy is the use of music by health care professionals to promote

healing and enhance quality of life for their patients. Music therapy may be used to

encourage emotional expression, promote social interaction, relieve symptoms, and

for other purposes. Music therapists may use active or passive methods with patients,

depending on the individual patient’s needs and abilities.”

- American Music therapy association

Intervention : music therapy.

Frequency : two session morning and evening.

Duration of section : 15-20 min.

Duration of therapy : second and third post operative day

3.15. ETHICAL CONSIDERATION

This study was conducted after the approval from the ethics committee

Madurai medical college, Madurai-3. All respondents were carefully informed about

the purpose of the study and their part during the study and how the privacy was

guarded. Ensured confidentiality of the study result. Thus the investigator followed

the ethical guidelines which were issued by the research committee. Written

permission was obtained from all participants.

45 
 
 3.16. DATA COLLECTION PROCEDURE

After obtaining written permission from the Principal, College of Nursing,

Director, Institute of Child Health and Research Centre, Ethical committee. On the

first day of data collection, the investigator introduced herself and explained the

nature and purpose of the study to the mothers of post operative children. Consent

was obtained to participate in the study and confidentiality of their responses was

assured. Pretest were conducted in post operative ward children in 6-12 years and 60

no (30 experimental group, 30 Control group) of samples selected by a Probability-

simple random sampling method. The investigator started the study in the post

operative ward (from12.08.2014 to 15.09. 2014).

The data were collected in three phases.

• Phase 1 : Pre test: The level of post operative pain were assessed with the

help of visual analogue scale before intervention in both experimental and

control group.

• Phase II :Intervention: In experimental group, Music therapy were

administered through head phone for 15-20 minutes for two sessions, morning

and evening. The music used will be Indian classical instrumental music like

Neelambari raga..

• Phase III: Post test: The level of post operative pain were reassessed with the

help of visual analogue scale for both group.

3.17. PLAN FOR DATA ANALYSIS

The data were planned to be analyzed in terms of the objectives of the study

using descriptive and inferential statistics.

46 
 
Descriptive statistics include

1) Frequency and percentage distribution of demographic variables.

2) Mean and standard deviations of pre assessment and post assesssment of pain

level and physiological parameters.

Inferential statistics include

1) Student paired ‘t’ test for comparison of pre assessment and post assessment

experimental group to assess the effectiveness of music therapy

2) Unpaired ‘t’ test for comparison of post test between control and experimental

group to assess the effectiveness of music therapy.

3) Chi square test is used to associate the demographic variables with the post

test of both group.

3.18 PRODUCTION OF HUMAN RIGHTS:

Research proposal was approved by the dissertation committee, prior to the

pilot study and the main study permission was obtained from the Head of the

Department of Paediatrics, in Institute of Child Health and Research Centre, at

Government Rajaji Hospital, Madurai. An oral and written consent of each study

samples was obtained before starting the data collection for pilot study. Positive

benefits were explained to all the study subjects. They were also be explained that

they may withdraw from the study at any time without any penalty. Assurance was

given to the subjects that confidentiality could be maintained throughout the study.

Debriefing of the study results is done after the approval of dissertations.

47 
 
 FIG: 2 SCHEMATIC REPRESENTATION OF THE RESEARCH
RESEARCH APPROACH
v
Quantitative approach

RESEARCH DESIGN
True experimental - pretest posttest control group design

STUDY POPULATION
Target population - Children undergone surgical procedures
Accessible population - Children undergone surgical procedures in post operative ward,
Institute of Child Health and Research Centre,GRH, Madurai.

SAMPLE
children those who are under gone surgical procedures in post operative ward, Institute of
Child health and research centre, Madurai, those who fulfilled the inclusion criteria.

SAMPLE SIZE - 60 childrens (30-Experimental group and 30-Control group)

SAMPLING TECHNIQUE : Simple random sampling technique

TOOL: Demographic variables,Visual analog pain scale

PRE TEST

EXPERIMENTAL CONTROL
GROUP GROUP

Music therapy Without Music therapy

Routine care Routinecare

POSTTEST
Using with visual analogue pain scale

Data analysis and Interpretation

Findings and conclusion

48 
 
Data Analysis And
Interpretation
 CHAPTER – IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis of data collected from 60 children in the

age group of 6 to 12 years admitted in the post operative ward in Institute of Child

Health and Research Centre , at GRH Madurai. The data findings have been tabulated

and interpreted according to the plan for data analysis.

ORGANIZATION OF THE DATA

Section – I : Distribution of children undergone surgical procedures, with their

related demographic variables in both groups.

Section–II: Description of level of pain among children undergone surgical

procedures, in experimental group and control group.

Section-III: Description of the effectiveness of music therapy among children

undergone surgical procedures, in experimental group.

Section – IV: Comparition of the post test level of pain among children

undergone surgical procedures, in experimental group and control

group.

Section-V : Association of the level of pain amongchildren undergone surgical

procedures, with their selected demographic variables in both

groups.

49 
 
 SECTION – I
Distribution of children undergone surgical procedures, with their related
demographic variables in both groups.

TABLE - 1
Frequency and percentage distribution of samples according to demographic variables
n = 60
Experimental
Control group
Demographic variables group
f % f %
1.Age of the child
6-8years 14 46.7 11 36.7
8-10years 11 36.7 14 46.7
10 -12years 5 16.7 5 16.7
2.Gender
Male 20 66.7 16 53.3
Female 10 33.3 14 46.7
3.Religion
Hindu 19 63.3 13 43.3
Muslim 7 23.3 11 36.7
Christian 4 13.3 6 20
Others 0 0 0 0
4.Place of birth
Urban 12 40 9 30
Rural 12 40 14 46.7
Semi urban 6 20 7 23.3
5.Education of the child
Istd - IIstd 11 36.7 9 30
III-std - IV std 13 43.3 14 46.7
IV-std - V std 6 20 7 23.3
VI and above 0 0 0 0

50 
 
 Experimental
Control group
Demographic variables group
f % f %
6.Monthly income of the family
Rs.1000 - 2500 5 16.7 3 10
Rs.2500-3500 17 56.6 18 60
Rs.3500 - 4500 8 26.7 9 30
Rs.4500 & above 0 0 0 0
7.Previous hospitalization
IPD 4 13.3 5 16.7
OPD 6 20 7 23.3
Not hospitalization 20 66.7 18 60
8.Education of pwerents
Non formal education 22 73.3 18 60
9.Food habits
Vegetarian 8 26.7 12 40
Non-vegetarian 22 73.3 18 60
Natural food 0 0 0 0
Others 0 0 0 0
10.Music hearing habits
Through TV 10 33.3 7 23.3
Through radio 0 0 - 0
Cell phone 5 16.7 5 16.7
All the above 15 50 18 60

Above table reveals the demographic information of children those who

participated for the following study on A study to assess the effectiveness of Music

therapy on pain among children undergone surgical procedures, in Institute of Child

Health and Research Centre at GRH Madurai .

51 
 
 In considering the age wise distribution of children in the experimental group

(36.7%) 11 children were in 6 to 8 years of age, (46.7%) 14 children were 8 to 10

years of age and( 16.7%)5 children were in 10 to 12years of age. In the control

group (46.7 % )14of children were between 6 to 8 years of age, (36.7% )11 children

were in 8 to 10 years of age, (16.7%) 5 children were in 10 to 12 years of age

Regarding gender wise distribution in experimental group (66.7%) 20 children

were male children and (33.3%) 10 children were female. In the control group

(53.3%) 16 were male children and (46.7%) 14 were female children participated in

the study.

Based on the religion wise distribution in experimental group (43.3% )

13 children were Hindus, (36.7%) 11 children were Christians, and (20%) 6 children

were Muslims. In the control group around (63.3%) 19 children were Hindus,

(23.3%) 7 children were Christians, and (13.3%) 4 children were Muslims.

Considering the place of residence of the study participants in the

experimental group (30%) 9 children were lives in urban area, (46.7%)

14 children were lives in rural area, and (23.3%) 7 children were lives in semi urban

areas. In the control group (40%) 12 children were lives in rural area (40%) 12

children were from urban wereas ,and (20%) 6 children were live in semi urban.

On basis of child education in experimental group (30%) 9 were studying in

1 to 2 Std, (46.7%) 14 were studying in 3 - 4 Std, and (23.3%) 7 were studying in 4 –

6 Std. In the control group the (36.7%) 11 were studying in 1 to 2 Std, (43.3%) 13

were studying in 3 - 4 Std, and (20%) 6 were studying in 4 – 6 Std.

With view of the monthly income of the family, In the experimental group

(10%) 3 of them have 1000-2500 Rs per month, (60%) 18 of them have 2500-3500

Rs per month, and (30%) 9 of them have 3500-4500 Rs per month. In the control

52 
 
 group (16.7% ) 5 of them have 1000-2500 Rs per month, (56.6%) 17 of them have

2500-3500 Rs per month, and (26.7%) 8 of them have 3500-4500 Rs per month.

In considering the previous exposure of hospitalization, In experimental group

(16.7%) 5 children having experience in Inpatient department, (23.3% )7 children

were having experience of Outpatient department, and (60%) 18 of children has not

hospitalized. In control group (13.3%) 4 children having experience in Inpatient

department, (20%) 6 children having experience of Outpatient department, and

(66.7%) 20 of children has not hospitalized.

When considering the education of the parents, In experimental group

(60%)18 parents having non formal education, (20%) 24 parents having primary

education, and (20%) 6 parents having high school education. In the control group

(73.3%) 22 parents having non formal education, (13.3%) 4 parents having primary

education, and (13.3%) 4 parents having high school education.

Regarding the food habits of the children, In experimental group (40%)12 of

them taking vegetarian foods, and (60)%18 of them taking non –vegetarian foods. In

control group (26.7%) 8 of them taking vegetarian foods, and (73.3%)22 of them

taking non –vegetarian foods.

When considering a Music hearing habits of the children, In experimental

group (23.3%) 7 of them hearing music through the television, (16.7%) 5 of them

hearing music through the cell phone, and (60%) 18 of them hearing music through

the television, radio, and cellphone. In control group (33.3%)10 of them hearing

music through the television, (16.7%)5of them hearing music through the cell

phone, and (50%)15 of them hearing music through the television, radio, and

cellphone.

53 
 
 DISTR
RIBUTIO
ON OF AG
GE
C
Control group
E
Experiemntal group
g

46.77 46..7
50

36.7 36.7
40
% PERCENTAGE

30

1
16.7 16.7
20

10

0
6-8 years
y 8-10 yearss 10-12 years

Age of the child

dren years

Fig. 3. Percentage
P distributioon of subjeccts in Experrimental grroup and control
group
p according to their age.
a

Thee above cyylindrical baar diagram

m shows thaat majorityy of subjeccts were

(46.7%) 144 of them

m 6-8yrs agee group in control grouup and (46.77%) 14 of them
t 8-

10 yrs agee group in exxperimentall group.

54
 
 D
DISTRIB
BUTION OF
O GENDER
Conttrol group
Expeeriemntal gro
oup

80 66.77
53.3
60 46.7
Percentage

33.3
40

20

0
Maale Female
Gennder

Fig. 4. Peercentage distribution

d n of subjects in Experrimental grroup and co
ontrol
group
p according
g to their gender
g

Thee above cyylindrical baar diagram

m shows thaat majorityy of subjeccts were

(66.7% ) 20
2 of them male in control grou
up and (46..7% ) 14 oof them feemale in

experimenttal group.

55
 
 DISTRIBUT
TION OF RELIGIO
ON
Con
ntrol group
Exp
periemntal group
g

70 63.3
60
% PERCENTAGE

50 43..3
366.7
40
30 23.3
2
20
20 13.3
10 0 0
0
Hindu Muslim
m Christian Otheers

R
Religion

Fig. 5. Percentage
P distributioon of subjeccts in Experimental grroup and control
c
group according
a to
t their religion

Thee above cyylindrical baar diagram

m shows thaat majorityy of subjeccts were

(63.3%) 19
1 of them
m Hindu in control group and (443.3%) 13 oof them Hindu
H in

experimenntal group.

56
 
 DIST
TRIBUTION OF PLACE
P O BIRT
OF TH

Contrrol group
Experriemntal gro
oup
46.7
50
40 40
40
% Percentage

3
30
30 233.3
20
20

10

0
Urban Rural Semi urbaan

Place of birth
h

Fig. 6. Percentage
P distributioon of subjeccts in Experimental grroup and control
c
group acccording to their
t place of birth

The abovee cone diaggram showss that majorrity of subjjects were( 40%) 12 of them

Urban werrea in contrrol group annd (46.7%) 14 of them

m Rural werrea in experrimental

group.

57
 
 DISTRIBUTIO
ON OF EDUCATI
E ION OF THE
CHILD
Con
ntrol group

Exp
periemntal group
g
50 46.7
43.33

40 36.7
30
Percentage

30
23.3
20
20

10
0 0
0
Istd-IIstd
d IIIstd--Ivstd Ivsstd-Vstd V and abovee
VI

E
Education off the child

Fig. 7. Percentage
P distributioon of subjeccts in Experimental grroup and control
c

grooup accordiing to the education

e o their chilld
of

Thee above conne diagram shows

s that majority off subjects w
were (43.3%
%) 13 of

them III - IVstd in coontrol groupp and (46.7%

%) 14 of theem III - IV
Vstd in experrimental

group.

58
 
 DIS
STRIBUTIION OF MONTHLY
M Y INCOM
ME

6
60
56.6
60 Control group
50 Exp
periemntal group
g
Percentage

40 300
26.7
30
16.7
20 1
10
10 0 0
0
Rs.10000- Rs.25000- Rs.35000- Rs.45000
25000 35000 4500 & abovee

Mon
nthly incom
me of the family
f

Fig. 8. Percentage
P distributioon of subjeccts in Experimental grroup and control
c

g
group according to th
heir monthlly income

Thee above conne diagram shows thatt majority of

o subjects m
monthly inccome of

the familyy were (56.6%) 17 of them

t Rs.25
500-3500 inn control grroup and (60%) 18

of them Rss.2500-35000 in experim

mental grou
up.

59
 
 DISTRIB
D BUTION OF
O PREVIOUS
HO
OSPITAL
LIZATION
N

Conttrol group
Expeeriemntal grroup
800 66.7
60
600
Percentage

400
220 23.3
200 13.3116.7

0
IPD O
OPD Not
hosspitalization

Previo
ous hospitaalization

Fig. 9. Percentage
P distributioon of subjeccts in Experimental grroup and control
c

grou
up accordin
ng to their previous
p hoospitalizatiion

Thee above cyllindarical bar

b diagram
m shows thhat majorityy of subjeccts were

(66.7%) 200 of them Not

N hospitaalization in control grooup and (60%
%) 18 of th
hem Not

hospitalizeed previously in experiimental grou

up.

60
 
 DISTTRIBUTION
N OF EDUC
CATION OF
O PARENT
TS

80 73.3
70 6
60
60
Percentage
g

50
Conttrol group
40
30 Expeeriemntal grroup
20 20
20 13.3 13.3
10 0 0 0 0
0
No form
mal Primary High H
Higher Degreee
educatio
on school seccondary

Educcation of parrents

Fig. 10. Percentage

P e distributioon of subjeects in Expeerimental ggroup and control
c

grou
up accordin
ng to their education of pwerentts.

Thee above cyylindrical baar diagram

m shows thaat majorityy of subjeccts were

(73.3% ) 22
2 of them have No formal
f educcation in control
c grouup and (60%
%) 18 of

them havee No formal education in

i experimeental group.

61
 
 D
DISTRIBUTION OF FOOD
F HAB
BITS

Contrrol group
80 73.3
Experiemntal gro
oup
6
60
60
% Percentage

400
40
26.7

20
0 0 0 0
0
Vegetariaan Non-- Natu
ural Oth
hers
vegetarrian foo
od

Food hab
bits

Fig. 11. Percentage

P e distributioon of subjeects in Expeerimental ggroup and control
c

group according to their food habits.

Thee above cyylindrical baar diagram

m shows thaat majorityy of subjeccts were

(73.3%) 22 of them taking Nonn vegetarian

n in controll group andd (60%) 18 of them

taking Nonn vegetariann in experim

mental group
p.

62
 
 DISTR
RIBUTION OF MUSIC
C HEARIN
NG HABITS
S

Control group
60 Exp
periemntal group
g
600
500
500
400 33.3
Percentage

300 233.3
16.77 16.7
200
100
0 0
0
Through TV
T Through Radio
R Cell ph
hone All thee above

Music hearing
h hab
bits

Fig. 12. Percentage

P e distributioon of subjeects in Expeerimental ggroup and control
c
group accord
ding to the music hearring habits..

Thee above conne diargram

m shows thaat majority of subjects were (50%
%) 15 of

them hearing music through

t TV
V, Radio and
d cell phone in controol group and (60%)

18 of them
m hearing music
m througgh TV, Rad
dio and cell phone
p in exxperimental group.

63
 
 SECTION – II
Description of level of pain among children undergone surgical procedures, in
experimental group and control group.

Table -2
Frequency and percentage distribution of pretest level of pain among children in
control group

Control group - Pretest

Level of
2nd Day 2nd Day 3rd Day 3rd Day
pain
Morning Evening Morning Evening
f % f % f % f %

No - - - - - - - -

Mild - - - - - - - -

Moderat - - - - - - 1 3.3

Severe 30 100 30 100 30 100 29 96.

Total 30 100 30 100 30 100 30 100

In control group on 2nd Day Morning none of the participants had no mild,

moderate pain, (100%) 30 of the children were having severe pain. on 2nd Day

Evening none of them having no pain, mild, moderate pain, (100%) 30 of the

children were having severe pain. on 3rd Day Morning no pain, mild, moderate pain,

(100%) 30 of the children were having severe pain. on 3rd Day Evening none of the

participants had no mild pain, (3.3%) 1 of the children were having moderate pain,

(96.7%) 29 of the children were having severe pain.

64 
 
 Table - 3

Frequency and percentage distribution of pretest level of pain among children

in experimental group

Experimental group - Pretest

2nd Day - 2nd Day 3rd Day - 3rd Day

Level of Morning Evening Morning Evening

pain Pre test Pre test Pre test Pre test

f % f % f % f %

No - - - - - - - -

Mild - - - - - - 1 3.3

Moderate - - 9 30 30 100 29 96.7

Severe 30 100 21 70 - - - -

Total 30 100 30 100 30 100 30 100

In experimental group on 2nd Day Morning none of the participants had no

mild, moderate pain, (100%) 30 of the children were having severe pain. on 2nd Day

Evening none of the participants had no mild, (30%) 9 of the children were having

moderate pain, (70%) 21 of the children were having severe pain. on 3rd Day

Morning none of the participants had no mild pain,(100%) 30 of the children were

having moderate pain, None of the participants had no severe pain. on 3rd Day

Evening (3.3%) 1 of the children having mild pain, (96.7%) 29 of the children were

having moderate pain, None of the participants had no severe pain.

65 
 
 Table - 4
Frequency and percentage distribution of posttest level of pain among children
in control group

Control group - Posttest

Level of pain 2nd Day 2nd Day 3rd Day - 3rd Day
Morning Evening Morning Evening
f % f % f % f %

No - - - - - - - -

Mild - - - - - - - -

Moderate - - - - - - 1 3.3

Severe 30 100 30 100 30 100 29 96.7

Total 30 100 30 100 30 100 30 100

In control group on 2nd Day Morning none of the participants had mild,

moderate pain, (100%) 30 of the children were having severe pain. on 2nd Day

Evening none of them having no pain, mild, moderate pain, (100%) 30 of the

children were having severe pain. on 3rd Day Morning no pain, mild, moderate pain,

(100%) 30 of the children were having severe pain. on 3rd Day Evening none of the

participants had no mild pain, (3.3%) 1 of the children were having moderate pain,

(96.7%) 29 of the children were having severe pain.

66 
 
 Table -5
Frequency and percentage distribution of posttest level of pain among children
in experimental group

Experimental group - Posttest

2nd Day 2nd Day 3rd Day

3rd Day -Morning
Level of pain Morning Evening Evening

f % f % f % f %

No - - - - - - - -

Mild - - - - - - 24 80

Moderate 4 13.3 28 93.3 30 100 6 20

Severe 26 86.7 2 6.7 - - - -

Total 30 100 30 100 30 100 30 100

In experimental group on 2nd Day Morning none of the participants had no

mild, (13.3%) 4 of the children were having moderate pain, (86.7%) 26 of the

children were having severe pain. on 2nd Day Evening none of the participants had no

mild pain, (93.3%) 28 of the children were having moderate pain, (6.7%) 2 of the

children were having severe pain. on 3rd Day Morning none of the participants had

no mild pain, (100%) 30 of the children were having moderate pain, none of the

participants had no severe pain. In 3rd Day Evening none of them having no pain,

(80%) 24 of the children having mild pain, (20%) 6 of the children were having

moderate pain, None of the participants had no severe pain.

67 
 
 SECTION – III

Description of the effectiveness of music therapy among children undergone

surgical procedures, in experimental group.

Table -6
Effectiveness of Music therapy on pain among children in experimental group.

Pain Experimental Group Experimental Group

Post pre test post test Mean
t-value p-value
operative Difference
day
Range Mean SD Range Mean SD
nd
2 day-
7-9 8.2 0.66 6-8 7.23 0.68 0.97 29 0.000***
Morning
2nd day- 0.000**
6-8 6.77 0.57 5-7 5.83 0.53 0.94 20.14
Evening *

3rd day - 0.000**

5-6 5.46 0.51 4-5 4.56 0.50 0.9 16.15
Morning *

3rd day - 0.000**

3-5 4.16 0.46 3-4 3.2 0.41 0.96 29
Evening *

(* P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant )

This table reveals in pre-test, 2nd day-Morning mean scores and SD of

pain was8.2 and 0.66, in post test 2nd day-morning mean scores and SD of

pain was 7.23 and 0.68. the mean difference of pre test and post test was 0.97,

the calculated t- value was 29 and the p – value was 0.000, in pre-test, 3rd day-

evening mean scores and SD of pain was 4.16 and 0.46, in post test 3rd day-

evening mean scores and SD of pain was 3.2 and 0.41. the mean difference

of pre test and post test was 0.96, the calculated t- value was 29 and the p –

value was 0.000 so it is highly significant.

68 
 
 Table - 7
Effectiveness of Music therapy on systolic pressure among children in
experimental group.

Systolic Experimental Group Experimental Group

BP pre test post test Mean t-
Post p-value
Difference value
operative
day Range Mean SD Range Mean SD

2nd day- 110- 100-

118 4.06 117 5.95 1 1.79 0.083
Morning 120 120

2nd day- 110- 100-

119 4.06 108.3 5.31 10.7 1.11 0.275
Evening 120 120

3rd day - 100- 100- 0.000**

104.33 5.68 100.67 2.54 3.66 4.09
Morning 120 110 *

3rd day - 100- 100-

100.33 1.83 98.33 1.82 2 3.21 0.011*
Evening 110 110

(* P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant)

This table reveals in pre-test, 2nd day-Morning mean scores and SD of

systolic pressure was118 and 4.06, in post test 2nd day-morning mean scores

and SD of systolic pressure was 117 and 5.95. the mean difference of pre test

and post test was 1, the calculated t- value was 1.79 and the p – value was

0.083, in pre-test, 3rd day-evening mean scores and SD of systolic pressure

was 100.3 and 1.83, in post test 3rd day-evening mean scores and SD of

systolic pressure was 98.33 and 1.82. the mean difference of pre test and post

test was 2, the calculated t- value was 3.21 and the p – value was 0.0011 so it

is highly significant.

69 
 
 Table - 8
Effectiveness of Music therapy on diastolic pressure among children in
experimental group.

Diastolic Experimental Group Experimental Group

BP pre test post test
Mean
Post t-
Difference p-value
operative Range Mean SD Range Mean SD value
day
2nd day- 0.000**
70-90 76.67 6.06 60-80 68 6.10 8.67 10.93
Morning *
nd
2 day-
60-80 66 5.63 60-70 65.67 5.04 0.33 0.27 0.786
Evening
3rd day –
60-70 61.67 3.79 60-70 61 3.05 0.6 1.44 0.161
Morning
3rd day –
60-70 61 3.05 60-70 60.3 1.82 0.7 1.99 0.015*
Evening
( * P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant )

This table reveals in pre-test, 2nd day-Morning mean scores and SD of

diastolic pressure was 76.67 and 6.06, in post test 2nd day-evening mean

scores and SD of diastolic pressure was 68 and 6.10. the mean difference of

pre test and post test was 8.67, the calculated t- value was 10.93 and the

p – value is 0.000. so it is highly significant.

70 
 
 Table - 9

Effectiveness of Music therapy on pulse rate among children in experimental

group.

Pulse Experimental Group Experimental Group

rate pre test post test
Mean t-
Post p-value
Difference value
operative Range Mean SD Range Mean SD
day
2nd day-
94-98 96.8 1.12 92-96 95.06 1.14 1.74 13.73 0.000***
Morning
2nd day- 0.000**
92-96 93.73 1.14 90-94 91.8 1.21 1.93 29
Evening *
3rd day – 11.5 0.000**
88-94 90.4 1.69 86-92 88.3 1.49 2.1
Morning 5 *
3rd day – 0.000**
84-88 86.93 1.26 84-88 85.67 1.06 1.26 7.08
Evening *
(* P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant)

This table reveals in pre-test, 2nd day-Morning mean scores and SD of

pulse rate was 96.8and 1.12, in post test 2nd day-morning mean scores and

SD of pulse rate was 95.06 and 1.14. the mean difference of pre test and post

test was 1.74, the calculated t- value was 13.73 and the p – value was 0.000,

in pre-test, 3rd day-evening mean scores and SD of pulse rate was 86.93 and

1.26, in post test 3rd day-evening mean scores and SD of pulse rate was

85.67 and 1.06. the mean difference of pre test and post test was 1.26, the

calculated t- value was 7.08 and the p – value was 0.000 so it is highly

significant.

71 
 
 Table. 10
Effectiveness of Music therapy on respiration rate among children in
experimental group

Respiratory Experimental Group Experimental Group

Post pre test post test Mean
t-value p-value
operative Difference
Range Mean SD Range Mean SD
day
2nd day-
32-38 36.4 1.42 30-36 34.13 1.56 2.27 12.23 0.000***
Morning
2nd day- 0.000**
30-36 32.8 1.35 28-34 30.27 1.17 2.53 13.59
Evening *
rd
3 day - 0.000**
28-32 30.13 1.38 24-32 26.93 1.55 3.2 4.96
Morning *
3rd day - 0.000**
24-32 26.93 1.55 22-30 24.93 1.72 2 12.04
Evening *
(* P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant)

This table reveals in pre-test, 2nd day-Morning mean scores and SD of

respiratory rate was 36.4 and 1.42, in post test 2nd day-morning mean scores

and SD of respiratory rate was 34.13 and 1.56. the mean difference of pre test

and post test was 2.27, the calculated t- value was 12.23 and the p – value was

0.000, in pre-test, 3rd day-evening mean scores and SD of respiratory rate was

26.93 and 1.55, in post test 3rd day-evening mean scores and SD of

respiratory rate was 24.93 and 1.72. the mean difference of pre test and post

test was 2, the calculated t- value was 12.04 and the p – value was 0.000 so it

is highly significant.

72 
 
 SECTION-IV
Comparition of the post test level of pain among children undergone surgical
procedures, in experimental group and control group.

Table. 11
Comparition of the post test level of pain among children in control group and
experimental group

Pain Control Group Experimental Group

Post post test post test Mean t-
p-value
operative Difference value
day
Range Mean SD Range Mean SD
nd
2 day-
7-9 8.3 0.54 6-8 7.23 0.68 1.07 6.91 0.000***
Morning
2nd day- 0.000**
7-9 8.33 0.53 5-7 5.83 0.53 2.5 17.97
Evening *
rd
3 day - 0.000**
6-8 7.33 0.54 4-5 4.56 0.50 2.77 20.38
Morning *
3rd day - 0.000**
6-8 7.33 0.53 3-4 3.2 0.41 4.13 33.22
Evening *
( * P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant )

This table reveals that post test score of mean and SD of experimental

group and control group. In control group 2nd day-Morning post test mean

scores and SD of pain was 8.3 and 0.54, in experimental group 2nd day-

morning post test mean scores and SD of pain was 7.23 and 0.68. the mean

difference of control and experimental group was 1.07, the calculated t- value

was 6.91 and the p – value was 0.000. In control group 3rd day-evening post

test mean scores and SD of pain was 7.33 and 0.53, in experimental group 3rd

day-evening post test mean scores and SD of pain was 3.2 and 0.41. the mean

difference of control and experimental group was 4.13, the calculated t- value

was 33.22 and the p – value was 0.000 so it is highly significant.

73 
 
 Table – 12
Comparition of the post test level of systolic blood pressure among children in
control group and experimental group

Systolic Control Group Experimental Group

BP post test post test
Mean t-
Post p-value
Difference value
operative Range Mean SD Range Mean SD
day
2nd day- 120- 120 0 100- 117 5.95 3 2.75 0.007**
Morning 120 120
nd
2 day- 110- 119.18 1.83 100- 108.3 5.31 10.9 12.78 0.000**
Evening 120 120 *
3rd day - 110- 113.33 4.79 100- 100.67 2.54 12.67 18.11 0.000**
Morning 120 110 *
3rd day - 110- 110.67 2.53 100- 98.33 1.82 12.34 14.78 0.000**
Evening 120 110 *
(* P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant)

This table reveals that post test score of mean and SD of experimental

group and control group. In control group 2nd day-Morning post test mean

scores and SD of sysstolic pressure was 120 and 0, in experimental group 2nd

day-morning post test mean scores and SD of diastolic pressure was 117 and

5.95. the mean difference of control and experimental group was 3, the

calculated t- value was 2.75 and the p – value was 0.007. in control group 3rd

day-evening post test mean scores and SD of systolic pressure was 110.67 and

2.53, in experimental group 3rd day-evening post test mean scores and SD of

systolic pressure was 98.33 and 1.82. the mean difference of control and

experimental group was 12.34, the calculated t- value was 14.78 and the

p – value was 0.000 so it is highly significant.

74 
 
 Table – 13
Comparition of the post test level of diastolic blood pressure among children in
control group and experimental group

Diastolic Control Group Experimental Group

BP post test post test
Mean t-
Post p-value
Difference value
operative Rnge Mean SD Range Mean SD
day
2nd day-
60-80 70.67 6.39 60-80 68 6.10 2.67 1.65 0.103
Morning
2nd day-
60-70 65.53 4.97 60-70 65.67 5.04 0.14 0.103 0.918
Evening
3rd day - 0.000**
60-80 68 6.10 60-70 61 3.05 7 5.61
Morning *
3rd day - 0.000**
60-80 65.67 5.68 60-70 60.3 1.82 5.37 4.89
Evening *
(* P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant)

This table reveals that post test score of mean and SD of experimental

group and control group. In control group 2nd day-Morning post test mean

scores and SD of diastolic pressure was 70.67 and 6.39, in experimental

group 2nd day-morning post test mean scores and SD of diastolic pressure was

68 and 6.10. the mean difference of control and experimental group was 2.67,

the calculated t- value was 1.65 and the p – value was 0.103. in control group

3rd day-evening post test mean scores and SD of diastolic pressure was 65.67

and 5.68, in experimental group 3rd day-evening post test mean scores and SD

of diastolic pressure was 60.3 and 1.82. the mean difference of control and

experimental group was 5.37, the calculated t- value was 4.89 and the

p – value was 0.000 so it is highly significant.

75 
 
 Table - 14
Comparition of the post test level of pulse rate among children in control group
and experimental group

Pulse Control Group Experimental Group post

rate post test test
Mean t-
Post p-value
Difference value
operative Range Mean SD Range Mean SD
day
2nd day-
90-98 94.5 1.96 92-96 95.06 1.14 0.56 1.28 0.203
Morning
2nd day- 0.000**
90-98 93.66 1.75 90-94 91.8 1.21 1.8 4.80
Evening *
rd
3 day - 0.000**
88-96 92.06 1.78 86-92 88.3 1.49 3.76 8.801
Morning *
3rd day - 0.000**
88-94 91.27 1.53 84-88 85.67 1.06 5.6 16.47
Evening *
( * P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant )

This table reveals that post test score of mean and SD of experimental

group and control group. In control group 2nd day-Morning post test mean

scores and SD of pulse rate was 94.5and 1.96, in experimental group 2nd day-

morning post test mean scores and SD of pulse was 95.06 and 1.14. the mean

difference of control and experimental group was 0.56, the calculated t- value

was 1.28 and the p – value was 0.203. In control group 3rd day-evening post

test mean scores and SD of pulse rate was 91.27 and 1.53, in experimental

group 3rd day-evening post test mean scores and SD of pulse rate was 91.27

and 1.53. the mean difference of control and experimental group was 5.6, the

calculated t- value was 16.47 and the p – value was 0.000 so it is highly

significant.

76 
 
 Table - 15
Comparition of the post test level of respiration rate among children in control
group and experimental group

Respirator Control Group Experimental Group post

y rate post test test
Mean
Post t-value p-value
Difference
operative Range Mean SD Range Mean SD
day
2nd day-
30-38 34.6 2.11 30-36 34.13 1.56 0.44 0.97 0.335
Morning
2nd day-
30-36 33.46 1.96 28-34 30.27 8.17 3.19 0.13 0.897
Evening
3rd day - 0.000**
28-36 32.33 1.97 24-32 26.93 1.55 5.4 8.72
Morning *
3rd day - 0.000**
28-34 31.07 2.08 22-30 24.93 1.72 6.14 12.43
Evening *
( * P<0.05 Significant , ** p<0.01 and *** P<0.001 highly significant )

This table reveals that post test score of mean and SD of experimental

group and control group. In control group 2nd day-Morning post test mean

scores and SD of respiratory rate was 34.6 and 2.11, in experimental group

2nd day-morning post test mean scores and SD of respiratory rate was 34.13

and 1.56. the mean difference of control and experimental group was 0.44,

the calculated t- value was 0.97 and the p – value was 0.335. In control group

3rd day-evening post test mean scores and SD of respiratory rate was 31.07 and

2.08, in experimental group 3rd day-evening post test mean scores and SD of

respiratory rate was 24.93 and 1.72. the mean difference of control and

experimental group was 6.14, the calculated t- value was 12.43 and the p –

value was 0.000 so it is highly significant.

77 
 
 SECTION-V
Association of the level of pain among children undergone surgical procedures,
with their selected demographic variables in both groups.

Table -16
Association between the post test level of pain and selected demographic variables
of the children in control group 3rd post operative day morning
n=30

Demographic No Mild Moderate Severe Chi p-

variables f % f % f % f % squwere value
1.Age of the
child
6-8 years - - - - 0 0 14 46.7 1.78 0.40
8-10years - - - - 1 3.3 10 33.3 (df=2) 9
10 -12years - - - - 0 0 5 16.7
2.Gender
Male - - - - 0 0 20 66.7 2.07 0.15
Female - - - - 1 3.3 9 30 (df=1) 0
3.Religion
Hindu - - - - 1 3.3 18 60
Muslim - - - - 0 0 7 23.3 0.59 0.74
Christian - - - - 0 0 4 13.3 (df=2) 1
Others - - - - 0 0 0 0
4.Place of birth
Urban - - - - 1 3.3 11 36.7 1.55 0.46
Rural - - - - 0 0 12 40 (df=2) 0
Semi urban - - - - 0 0 6 20
5.Education of
the child
Istd - IIstd - - - - 0 0 11 36.7
III-std - IV std - - - - 1 3.3 12 40 1.35 0.50
IV-std - V std - - - - 0 0 6 20 (df=2) 8
VI and above - - - - 0 0 0 0

78 
 
 Demographic No Mild Moderate Severe Chi p-
variables f % f % f % f % squwere value
6.Monthly
income of the
family
Rs.1000 - 2500 - - - - 0 0 5 16.7
Rs.2500-3500 - - - - 1 3.3 16 53.3 0.79 0.67
Rs.3500 - 4500 - - - - 0 0 8 26.7 (df=2) 3
Rs.4500 & above - - - - 0 0 0 0
7.Previous
hospitalization
IPD - - - - 0 0 4 13.3 0.517 0.77
OPD - - - - 0 0 6 20 (df=2) 2
Not - - - - 1 3.3 19 63.3
hospitalization
8.Education of
pwerents
Non formal - - - - 1 3.3 21 70 0.376 0.82
education (df=2) 9
Primary - - - - 0 0 4 13.3
High school - - - - 0 0 4 13.3
Higher secondary - - - - 0 0 0 0
Degree - - - - 0 0 0 0
9.Food habits
Vegetarian - - - - 0 0 8 26.7 0.376
Non-vegetarian - - - - 1 3.3 21 70 (df=1) 0.540
Natural food - - - - 0 0 0 0
Others - - - - 0 0 0 0
10.Music hearing
habits
Through TV - - - - 0 0 10 33.3
Through radio - - - - 0 0 0 0 1.03 0.596
Cell phone - - - - 0 0 5 16.7 (df=2)
All the above - - - - 1 3.3 14 46.7
(*-P<0.05 ,significant and **-P<0.01 & ***-P<0.001 , Highly significant )

There was a no significant association found between the 3rd post operative

day morning, post test of control group with selected demographic variables.

79 
 
 Table- 17
Association between the post test level of pain and selected demographic
variables of the children in control group 3rd post operative day evening
n=30

Moderat
Demographic No Mild Severe chi - p-
e
variables squwere value
f % f % f % f %
1.Age of the child
6-8 years - - - - 0 0 14 46.7 1.78 0.40
8-10 years - - - - 1 3.3 10 33.3 (df=2) 9
10 -12 years - - - - 0 0 5 16.7
2.Gender
Male - - - - 0 0 20 66.7 2.06 0.15
Female - - - - 1 3.3 9 30 (df=1) 0
3.Religion
Hindu - - - - 1 3.3 18 60
Muslim - - - - 0 0 7 23.3 0.59 0.74
Christian - - - - 0 0 4 13.3 (df=2) 1
Others - - - - 0 0 0 0
4.Place of birth
Urban - - - - 1 3.3 11 36.7 1.55
Rural - - - - 0 0 12 40 (df=2) 0.46
Semi urban - - - - 0 0 6 20 0
5.Education of the
child
Istd - IIstd - - - - 0 0 11 36.7 1.35 0.50
III-std - IV std - - - - 1 3.3 12 40 (df=2) 8
IV-std - V std - - - - 0 0 6 20
VI and above - - - - 0 0 0 0
6.Monthly income
of the family
Rs.1000 - 2500 - - - - 0 0 5 16.7
Rs.2500-3500 - - - - 1 3.3 16 53.3 0.79 0.67
Rs.3500 - 4500 - - - - 0 0 8 26.7 (df=2) 3
Rs.4500 & above - - - - 0 0 0 0

80 
 
 Moderat
Demographic No Mild Severe chi - p-
e
variables squwere value
f % f % f % f %
7.Previous
hospitalization
IPD - - - - 0 0 4 13.3 0.517 0.77
OPD - - - - 0 0 6 20 (df=2) 2
Not hospitalization - - - - 1 3.3 19 63.3

8.Education of
pwerents
Non formal - - - - 1 3.3 21 70 0.376
education (df=2) 0.82
Primary - - - - 0 0 4 13.3 9
High school - - - - 0 0 4 13.3
Higher secondary - - - - 0 0 0 0
Degree - - - - 0 0 0 0
9.Food habits
Vegetarian - - - - 0 0 8 26.7
Non-vegetarian - - - - 1 3.3 21 70 0.376 0.54
Natural food - - - - 0 0 0 0 (df=1) 0
Others - - - - 0 0 0 0
10.Music hearing
habits
Through TV - - - - 0 0 10 33.3 1.03 0.59
Through radio - - - - 0 0 0 0 (df=2) 6
Cell phone - - - - 0 0 5 16.7
All the above - - - - 1 3.3 14 46.7
(*-P<0.05 ,significant and **-P<0.01 & ***-P<0.001 , Highly significant )

There was a no significant association found between the 3rd post operative

day evening, post test of control group with selected demographic variables.

81 
 
 Table - 18

Association between the post test level of pain and selected demographic
variables of the children in experimental group 3rd post operative day
morning
n=30

Demographic No Mild Moderate Severe Chi- p-

variables f % f % f % f % squwere value
1.Age of the child
6-8years - - - - 11 36.7 - -
8-10years - - - - 14 46.7 - - 0 1
- - - - 5 16.7 - -
10 -12years
2.Gender
Male - - - - 16 53.3 - -
Female - - - - 14 46.7 - - 0 1

3.Religion
Hindu - - - - 13 43.3 - -
Muslim - - - - 11 36.7 - - 0 1
- - - - 6 20 - -
Christian
- - - - 0 0 - -
Others
4.Place of birth
Urban - - - - 9 30 - -
Rural - - - - 14 46.7 - - 0 1
- - - - 7 23.3 - -
Semi urban
5.Education of
the child
Istd - IIstd - - - - 9 30 - - 0 1
- - - - 14 46.7 - -
III-std - IV std
- - - - 7 23.3 - -
IV-std - V std
- - - - 0 0 - -
VI and above
6.Monthly
income of the
family
- - - - 3 10 - - 0 1
Rs.1000 - 2500
- - - - 18 60 - -
Rs.2500-3500

82 
 
 Demographic No Mild Moderate Severe Chi- p-
variables f % f % f % f % squwere value
Rs.3500 - 4500 - - - - 9 30 - -
Rs.4500 & above - - - - 0 0 - -

7.Previous
hospitalization
IPD - - - - 5 16.7 - - 0 1
- - - - 7 23.3 - -
OPD
- - - - 18 60 - -
Not
hospitalization
8.Education of
pwerents
Non formal - - - - 18 60 - - 0 1

education
- - - - 6 20 - -
Primary
- - - - 6 20 - -
High school
- - - - - - - -
Higher secondary
- - - - - - - -
Degree

9.Food habits
Vegetarian - - - - 12 40 - -

Non-vegetarian - - - - 18 60 - - 0 1
- - - - 0 0 - -
Natural food
- - - - 0 0 - -
Others
10.Music hearing
habits
Through TV - - - - 7 23.3 - - 0 1
- - - - - 0 - -
Through radio
- - - - 5 16.7 - -
Cell phone
- - - - 18 60 - -
All the above

(*-P<0.05 ,significant and **-P<0.01 & ***-P<0.001 , Highly significant )

There was a no significant association found between the 3rd post operative

day morning, post test of expremental group with selected demographic variables.

83 
 
 Table- 19

Association between the post test level of pain and selected demographic
variables of the children in experimental group 3rd post operative day
evening.
n=30

Demographic No Mild Moderate Severe Χ2 p-

variables f % f % f % f % value value
1.Age of the
child
6-8years - - 10 33.3 1 3.3 - - 1.46 0.482
8-10years - - 10 33.3 4 13.3 - - (df=2)
10 -12years - - 4 13.3 1 3.3 - -
2.Gender
Male - - 15 50 1 3.3 - - 4.05 0.04*
Female - - 9 30 5 16.7 - - (df=1)
3.Religion
Hindu - - 11 33.3 2 6.7 - -
Muslim - - 9 30 2 6.7 - - 0.863 0.650
Christian - - 4 13.3 2 6.7 - - (df=2)
Others - - 0 0 0 0 - -
4.Place of birth
Urban - - 8 26.7 1 3.3 - - 0.783 0.676
Rural - - 11 33.3 3 10 - - (df=2)
Semi urban - - 5 16.7 2 6.7 - -
5.Education of
the child
Istd - IIstd - - 7 23.3 2 6.7 - - 0.188 0.910
III-std - IV std - - 11 33.3 3 10 - - (df=2)
IV-std - V std - - 6 20 1 3.3 - -
VI and above - - 0 0 0 0 - -
6.Monthly
income of the
family
Rs.1000 - 2500 - - 1 3.3 2 6.7 - - 4.65 0.098

84 
 
 Demographic No Mild Moderate Severe Χ2 p-
variables f % f % f % f % value value
Rs.2500-3500 - - 15 50 3 10 - - (df=2)
Rs.3500 - 4500 - - 8 26.7 1 3.3 - -
Rs.4500 & above - - 0 0 0 0 - -
7.Previous
hospitalization
IPD - - 4 13.3 1 3.3 - - 0.446 0.80
OPD - - 5 16.7 2 6.7 - - (df=2)
Not - - 15 50 3 10 - -
hospitalization
8.Education of
the parents
Non formal - - 13 43.3 5 16.7 - -
education 2.22 0.329
Primary - - 5 16.7 1 .3 - - (df=2)
High school - - 6 20 0 0 - -
Higher secondary - - 0 0 0 0 - -
Degree - - - -
9.Food habits
Vegetarian - - 11 36.7 1 3.3 - -
Non-vegetarian - - 13 21.7 5 16.7 - - 1.701 0.192
Natural food - - 0 0 0 0 - - (df=1)
Others - - 0 0 0 0 - -
10.Music
hearing habits
Through TV - - 6 20 1 3.3 - - 1.52 0.468
Through radio - - 0 0 0 0 - - (df=2)
Cell phone - - 3 10 2 6.7 - -
All the above - - 15 50 3 10 - -
(*-P<0.05 ,significant and **-P<0.01 & ***-P<0.001 , Highly significant )

There was a no significant association found between the 3rd post operative

day evening, post test of expremental group with selected demographic variables.

85 
 
Discussion
 CHAPTER-V
DISCUSSION
 

This chapter deals with the findings of the study based on the interpretation of

the statistical analysis. The findings were discussed in relation to the objectives of

the study. The findings were supported by the review of literature.

The purpose of the study is to assess the Effectiveness of Music therapy on

pain among children undergone surgical procedures, in Instituteof Child Health and

Research Centre at Government Rajaji Hospital, Madurai.

5.1 DEMOGRAPHIC DETAILS OF THE STUDY

In considering the age wise distribution of children in the experimental group

(36.7%) 11 children were in 6 to 8 years of age, (46.7%) 14 children were 8 to 10

years of age and (16.7%)5 children were in 10 to 12years of age. In the control

group (46.7 % )14of children were between 6 to 8 years of age, (36.7% )11 children

were in 8 to 10 years of age, (16.7%) 5 children were in 10 to 12 years of age

Regarding gender wise distribution in experimental group (66.7%) 20 children

were male children and (33.3%) 10 children were female. In the control group

(53.3%) 16 were male children and (46.7%) 14 were female children participated in

the study.

Based on the religion wise distribution in experimental group (43.3% )13

children were Hindus, (36.7%) 11 children were Christians, and (20%) 6 children

were Muslims. In the control group around (63.3%) 19 children were Hindus,

(23.3%) 7 children were Christians, and (13.3%) 4 children were Muslims.

86 
 
 Considering the place of residence of the study participants in the

experimental group (30%) 9 children were lives in urban wereas,( 46.7%) 14

children were lives in rural wereas, and (23.3%) 7 children were lives in semi urban

wereas. In the control group (40%) 12 children were lives in rural wereas , (40%) 12

children were from urban wereas ,and (20%) 6 children were live in semi urban.

On basis of child education in experimental group (30%) 9 were studying in

1 to 2 Std, (46.7%) 14 were studying in 3 - 4 Std, and (23.3%) 7 were studying in 4 –

6 Std. In the control group the (36.7%) 11 were studying in 1 to 2 Std, (43.3%) 13

were studying in 3 - 4 Std, and (20%) 6 were studying in 4 – 6 Std.

With view of the monthly income of the family, In the experimental group

(10%) 3 of them have 1000-2500 Rs per month,(60%) 18 of them have 2500-3500

Rs per month, and (30%) 9 of them have 3500-4500 Rs per month. In the control

group (16.7% ) 5 of them have 1000-2500 Rs per month, (56.6%) 17 of them have

2500-3500 Rs per month, and (26.7%) 8 of them have 3500-4500 Rs per month.

In considering the previous exposure of hospitalization, In experimental group

(16.7%) 5 children having experience in Inpatient department, (23.3% )7 children

were having experience of Outpatient department, and (60%) 18 of children has not

hospitalized. In control group (13.3%) 4 children having experience in Inpatient

department, (20%) 6 children having experience of Outpatient department, and

(66.7%) 20 of children has not hospitalized.

When considering the education of the parents,In experimental group (60%)18

parents having non formal education, (20%) 24 parents having primary education,

and (20%) 6 parents having high school education. In the control group (73.3%) 22

87 
 
 parents having non formal education, (13.3%) 4 parents having primary education,

and (13.3%) 4 parents having high school education.

Regarding the food habits of the children, In experimental group (40%)12 of

them taking vegetarian foods, and (60)%18 of them taking non –vegetarian foods. In

control group (26.7%) 8 of them taking vegetarian foods, and (73.3%)22 of them

taking non –vegetarian foods.

When considering a Music hearing habits of the children, In experimental

group (23.3%) 7 of them hearing music through the television, (16.7%) 5 of them

hearing music through the cell phone, and (60%) 18 of them hearing music through

the television, radio, and cellphone. In control group (33.3%)10 of them hearing

music through the television, (16.7%)5of them hearing music through the cell

phone, and (50%)15 of them hearing music through the television, radio, and

cellphone.

5.2 DISCUSSION OF OBJECTIVES

The first objective of the study was to assess the level of pain among

children undergone surgical procedures in experimental group and control

group.

Data were analyzed using descriptive statistics. Mean and standard deviation

of the level of pain. It represents the pretest score of the level of pain of the children.

In control group on 2nd Day Morning none of the participants had no mild,

moderate pain, (100%) 30 of the children were having severe pain. on 2nd Day

Evening none of them having no pain, mild, moderate pain, (100%) 30 of the

children were having severe pain. on 3rd Day Morning no pain, mild, moderate pain,

88 
 
 (100%) 30 of the children were having severe pain. on 3rd Day Evening none of the

participants had no mild pain, 3.3%(1) of the children were having moderate pain,

(96.7%) 29 of the children were having severe pain.

In experimental group on 2nd Day Morning none of the participants had no

mild, moderate pain, (100%) 30 of the children were having severe pain. on 2nd Day

Evening none of the participants had no mild, (30%) 9 of the children were having

moderate pain, (70%) 21 of the children were having severe pain. on 3rd Day

Morning none of the participants had no mild pain, (100%) 30 of the children were

having moderate pain, None of the participants had no severe pain. on 3rd Day

Evening (3.3%) 1 of the children having mild pain, (96.7%) 29 of the children were

having moderate pain, None of the participants had no severe pain.

It represents the posttest score of the level of pain of the children.

In control group on 2nd Day Morning none of the participants had mild,

moderate pain, (100%) 30 of the children were having severe pain. on 2nd Day

Evening none of them having no pain, mild, moderate pain, (100%) 30 of the

children were having severe pain. on 3rd Day Morning no pain, mild, moderate pain,

(100%) 30 of the children were having severe pain. on 3rd Day Evening none of the

participants had no mild pain, (3.3%) 1 of the children were having moderate pain,

96.7%(29) of the children were having severe pain.

In experimental group on 2nd Day Morning none of the participants had no

mild, (13.3%) 4 of the children were having moderate pain, (86.7%) 26 of the

children were having severe pain. on 2nd Day Evening none of the participants had no

mild pain, (93.3%) 28 of the children were having moderate pain, (6.7%) 2 of the

89 
 
 children were having severe pain. on 3rd Day Morning none of the participants had

no mild pain, (100%) 30 of the children were having moderate pain, none of the

participants had no severe pain. In 3rd Day Evening none of them having no pain,

(80%) 24 of the children having mild pain, (20%) 6 of the children were having

moderate pain, None of the participants had no severe pain.

In third POD evening the control group pain level reduced some level but not

compwere to experimental group pain level.

The second objective of the study was to evaluate the effectiveness of music

therapy on pain among children undergone surgical procedures in experimental

group.

In experimental group pre-test, 2nd day-Morning mean scores and SD of pain

was 8.2 and 0.66, in post test 2nd day-morning mean scores and SD of pain was

7.23 and 0.68. the mean difference of pre test and post test was 0.97, the calculated

t- value was 29 and the p – value was 0.000, in pre-test, 3rd day-evening mean scores

and SD of pain was 4.16 and 0.46, in post test 3rd day-evening mean scores and SD

of pain was 3.2 and 0.41. the mean difference of pre test and post test was 0.96, the

calculated t- value was 29 and the p – value was 0.000 so it is highly significant.

The experimental group pretest level of pain wsa higher than the post test

score the calculated table value was more than the table value(2.78) so it is

significant.

Sigma Theta Tau , (2009) conducted a study to assess and compwere the effect

of music therapy on postoperative pain of patient undergone elective abdominal

surgery. A quasi-experimental design was used and convenient samples of 30 (15 in

90 
 
 each exp & control group). Pain was measured by Verbal Rating Scale. Music

therapy was given as per patient’s wish to experimental group and intensity of pain

was monitored before and immediately after recovery from anesthesia, during the 1st

and 2nd postoperative day for both the groups. Results revealed that those patients

who listened to self selected music tapes had significant differences (p<0.001) in

pain scores when compwered to the control group. The conclusion of study shows

that the music is an effective anxiolitic (relaxing agent) which can be beneficial for

the early recovery of surgical patients.

Thus the Hypothesis 1 “There is a significant difference between the level

of pain among children undergone surgical procedures,of experimental group

after music therapy” was accepted.

The third objective was to compare the post test level of pain among

children undergone surgical procedures in experimental group and control

group.

The post test score of mean and SD of experimental group and control group.

In control group 2nd day-Morning post test mean scores and SD of pain was 8.3 and

0.54, in experimental group 2nd day-morning post test mean scores and SD of pain

was 7.23 and 0.68. the mean difference of control and experimental group was 1.07,

the calculated t- value was 6.91 and the p – value was 0.000. In control group 3rd

day-evening post test mean scores and SD of pain was 7.33 and 0.53, in experimental

group 3rd day-evening post test mean scores and SD of pain was 3.2 and 0.41. the

mean difference of control and experimental group was 4.13, the calculated t- value

was 33.22 and the p – value was 0.000.

91 
 
 The control group mean post test level of pain was (7.33) higher than the

experimental group mean post test level of pain (3.2).the mean difference between

post test of control and experimental grouplevel of pain was found to be significant.

In 3rd day-evening post test systolic pressure, mean difference of control and

experimental group was 12.34, the calculated t- value was 14.78 and the

p – value was 0.000 so it is highly significant.

In 3rd day-evening post test diastolic pressure, mean difference of

control and experimental group was 5.37, the calculated t- value was 4.89

and the p – value was 0.000 so it is highly significant.

In 3rd day-evening post test pulse rate, mean difference of control and

experimental group was 5.6, the calculated t- value was 16.47 and the

p – value was 0.000 so it is highly significant.

In 3rd day-evening post test respiratory rate, mean difference of control

and experimental group was 6.14, the calculated t- value was 12.43 and the

p – value was 0.000 so it is highly significant.

Physical parameters showed changes when the pain level is increased after

music therapy intervention the physiological parameter come to normal range

compare to the control group.

Profound physiologic changes often accompany the experience of pain.

Physiologic parameters such as heart rate, respiratory rate, blood pressure, palmar

sweating, cortisone levels, transcuatneous oxygen, vagal tone and endorphin

concentrations reflect a generalized and complex response to stress. They were not

92 
 
 localized responses to pain, but they provide useful information about the

generaldistress levels of children who were experiencing pain. Physiologic

parameters provide indirect estimates of pain and presence and strength of pain can

only be inferred from the changes in these parameters. Sweet and Mc Grath (1998).

Thus the Hypothesis 2 “There is a significant difference in the post test

level of pain among children undergone surgical procedures in experimental

group and control group” was accepted.

The fourth objective was to associate the level of pain among children

undergone surgical procedures with selected demographic variables in both

groups.

There was a no significant association found between the 3rd post operative

day morning and evening, post test of control group with selected demographic

variables.

There was a no significant association found between the 3rd post operative

day morning and evening, post test of expremental group with selected demographic

variables.

Thus the Hypothesis 3 “There is a significant association in the level of

pain among children undergone surgical procedures with selected demographic

variables in both groups” was detained.

93 
 
 Summary,
Conclusion &
Recommendations
 CHAPTER-VI

SUMMARY, CONCLUSION AND RECOMMENDATIONS

This chapter deals with the summary of the study and the conclusions drawn.

It clarifies the limitations of the study. The implications and recommendations are

given for different areas of Nursing such as practice, education, research and

administration in the Health care delivery system.

6.1. SUMMARY OF THE STUDY

Pain is the unpleasant sensory stimulation, especially in children. It will shape

their behavior in the future. The pain in children was underestimated and untreated in

many clinical settings. The role of the nurses is very important role in managing the

pain in children especially during the postoperative period. It helps the child to

develop confidence, cooperation and to reduce the anxiety during hospital

procedures. The family also needs to manage the child during the painful procedures.

Health care professionals have to set the responsibility to reduce the pain and anxiety

as much as possible. A Non-Pharmacological procedure shows very effective in

managing the pain. Cultural factors affect the pain perception in the children. Hence,

this study was undertaken to determine the effectiveness of music therapy on pain

among the children undergone abdominal surgeries on the second and third Post

operative day.Hence, this study was undertaken to determine the effectiveness of

music therapy on pain among children undergone surgical procedure, in G R H,

Madurai.

94 
 
 The following objectives were set for the study

 To assess the level of pain among children undergone surgical procedures in

experimental group and control group.

 To evaluate the effectiveness of music therapy on pain among children

undergone surgical procedures in experimental group.

 To compare the post test level of pain among children undergone surgical

procedures in experimental group and control group.

 To associate the level of pain among children undergone surgical procedures

with selected demographic variables in both groups

The study was based on the assumption that

 Children who are undergo surgery were susceptible to develop post operative

pain.

 Music therapy will minimized the pain level among children.

The following hypothesis were formulated

H1: There is a significant difference between the level of pain among children

undergone surgical procedures,of experimental group after music therapy.

H2: There is a significant difference in the post test level of pain among children

undergone surgical procedures in experimental group and control group.

H3: There is a significant association in the post test level of pain among children

undergone surgical procedures with selected demographic variables in both groups.

The variables studied were

Independent variable  Music therapy

Dependent variable  Pain in children

95 
 
 Extensive literature review and studies from primary and secondary focus

regarding the effects of music therapy on reducing post operative pain among

children provided evidence based guidance for the study. This has helped to design

the methodology, develop the tool for data collection and the protocol for

administering music therapy. The conceptual framework developed for the study was

based on the modified Kings Goal attainment Theory (1981).

The tool used for data collection was validated by the experts in the

department of Pediatric Surgery and Nursing. Reliability of the tool was assessed by

using inter rater reliability correlation coefficient. The instrument was found to be

reliable. A pilot study was conducted on ten samples to find out the appropriateness

and feasibility of conducting the study and it was found feasible.

The data collection was made for 6 weeks in the post operative wards, in

Institute of Child Health and Research centre, at GRH, Madurai. Formal permission

was obtained from the Director of the Institute and Head of the Department of

Pediatrics Surgery in Institute of Child Health and Research centre, at GRH,

Madurai.

The researcher adopted the true experimental research design to assess the

effectiveness of music therapy on reducing post operative pain among children 6-12

years. The simple random sampling technique was used to select 60 samples based

on the inclusion criteria.

Parents were explained about the purpose of the study and were assured of

confidentiality of the data collected. Adequate privacy was provided during the

procedure On the first day of sample selection, the demographic data were

96 
 
 collected,and conduct pretest on the second post operative day by using pain visual

analog scale and also moniter the physiological parameters then administered the

music therapy for experimental group through the head phone for 15-20 mts of two

session morning and evening. Post assessment of the level of pain was done after

therapy in experimental group with out therapy in control group using the same

visual analog scale was obtained.

Descriptive (percentage distribution, mean, standard deviation) and inferential

statistics (t- test, Pearson chi squwere test) were used to analyze the data and to test

hypothesis. The data were then interpreted and discussed based on the objectives of

the study, hypotheses and relevant studies from the literature reviewed.

6.2. MAJOR FINDINGS OF THE STUDY

The data collected was analyzed using both descriptive and inferential

statistics.

Among the school children, in control group (46.7%)14 were in the a-ge group

of 6-8years in experimental group, (46.7%) 14 were in the age group of the 8-10yrs.

Most of them (63.3%) 19 control group, (43.3% ) 13 experimental group

belong to Hindu.

Majority (66.7%) 20 control group, (53.3%) 16 experimental group children

were in male gender.

Most of the children (40%) 12 control group, (46.7%) 14 experimental group

were living in rural area.

Majority fo the children (43.3%) 13 control group, (46.7%) 14 were experimental

group were studied in 3-4standard

97 
 
 Majority of the children (56.6%) 17 control group, (60%) 18 experimental

group of them have family income between 2500 – 3000.

(66.7%) 20 control group, (60%) 18 experimental group of them children were

not hospitalized previously.

(73.3%) 22control group, (60%) 18 experimental group of parents not had

any formal education.

(73.3%) 22 control group, (60%) 18 experimental groupi of children were

non-vegetarian.

Majority of the children (50%) 15 control group, (60%) 18 experimental

group were hear music through TV, Radio, Cell phone.

The experimental group pretest level of pain wsa higher than the post test

score the calculated table value was more than the table value(2.78). the mean

difference of pre test and post test was 0.96, the calculated t- value was 29 and the

p – value was 0.000 so it is highly significant.

The control group mean post test level of pain was (7.33) higher than the

experimental group mean post test level of pain (3.2).the mean difference between

post test of control and experimental grouplevel of pain was found to be significant.

the mean difference of control and experimental group was 4.13, the calculated

t- value was 33.22 and the p – value was 0.000 so it is highly significant.

In 3rd day-evening post test systolic pressure, mean difference of control and

experimental group was 12.34, the calculated t-value was 14.78 and the

p – value was 0.000 so it is highly significant.

In 3rd day-evening post test diastolic pressure, mean difference of control and

experimental group was 5.37, the calculated t-value was 4.89 and the p –

value was 0.000 so it is highly significant.

98 
 
 In 3rd day-evening post test pulse rate, mean difference of control and

experimental group was 5.6, the calculated t- value was 16.47 and the

p – value was 0.000 so it is highly significant.

In 3rd day-evening post test respiratory rate, mean difference of control and

experimental group was 6.14, the calculated t- value was 12.43 and the

p – value was 0.000 so it is highly significant.

6.3 CONCLUSION

This study attempted to find out the Effectiveness of music therapy on

pain among children undergone surgical procedures. The children had inadequate

pain management after surgery. After administration of music therapy there was a

significant improvement in post operative pain management present. Music therapy

was found to be effective in reducing the pain in post operative among children. The

post assessment pain score was significantly lower the pre assessment. There was a

no significant association between selected demographic variables and pain

reduction in children undergone surgical procedures.

6.4. IMPLICATIONS

The implications drawn from the study are of vital concern to the field of

Nursing including Nursing service, Nursing Education, Nursing Research and

Nursing Administration.

IMPLICATIONS FOR NURSING PRACTICE

1. Nurse is the primary care giver and having responsibility in applying the

holistic approach while giving the care to the patient. Music therapy show should

include as a part of nursing care.

99 
 
 2. The study finding will help the Nursing personnel to manage the pain in

children during the postoperative period.

3. Regular timings of music therapy should be maintained in postoperative care

settings.

IMPLICATIONS FOR NURSING EDUCATION

Nursing is an evolving profession every practice is based on evidence based

care with adequate knowledge.

1. The Nurse educator should teach about the distraction therapies, it is very

effective and easy to administer.

2. Nurse educators should provide in-service education regarding benefits

nonpharmacological methods ( especially music therapy) of pain management.

3. Nurse educator can conduct Symposium, Seminars regarding the effect of the

Music therapy play in pain management in children.

IMPLICATIONS FOR NURSING RESEARCH

1. Help the Nursing researcher to focus and develop insight on the distraction

therapies

2. To do the further research in all post operative children

3. The management should motivate the researchers to find various types of

distraction therapies in post operative children on the basis of cost effectiveness

IMPLICATIONS FOR NURSING ADMINISTRATION

1. The Nurse administrator should prepwere the protocol for distraction therapies

especially music therapy play for the children who are admitted into the

hospitals.

100 
 
 2. The Nurse administrator should teach about the effectiveness of music therapy

to play in pain management among the post operative children.

6.5 RECOMMENDATIONS

1. A similar study can be conducted for all types of surgical patients.

2. The same study can be conducted in larger groups in different settings.

3. The same study can be used to minimize the fear and anxiety of the children.

4. Comparison study can be done by various distraction therapies.

5. This study can be done along with analgesics to improve the efficacy of the drugs.

6.6. LIMITATIONS

1) This study was done on a small sample size of 60; hence generalization is

possible only for the selected subjects from selected hospital.

2) The researcher found little difficulty in getting cooperation from the children.

101 
 
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ELECTRONIC VERSION
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9. http://www.medline.com
10. http://www.painclinic.com

106 
 
Appendices
 APPENDIX – I

 
APPENDIX – II
APPENDIX – III
 APPENDIX - IV

 
  

 
 

 
  

 
  

 
APPENDIX – V
 APPENDIX – VI

SECTION - A

DEMOGRAPHIC DATA

1. Age of the child

a. 6-8years
b. 8-10years
c. 10 -12years
2. Gender
a. Male
b. Female
3. Religion
a. Hindu
b. Muslim
c. Christian
d. Others
4. Place of birth
a. Urban
b. Rural
c. Semi urban
5. Education of the child
a. Istd - IIstd
b. III-std - IV std
c. IV-std - V std
d. VI and above
6. Monthly income of the family
a. Rs.1000 - 2500
b. Rs.2500-3500
c. Rs.3500 - 4500
d. Rs.4500 & above
 

 
7. Previous hospitalization
a. IPD
b. OPD
c. Nothospitalization
8. Education of parents
a. Non formal education
b. Primary
c. High school
d. Higher secondary
e. Degree
9. Food habits
a. Veg
b. Non-veg
c. Natural food
d. Others
10. Music hearing habits
a. Through TV
b. Through radio
c. Cell phone
d. All the above
 SECTION –B

NUMERICAL PAIN SCALE

Scoring Method

Data Scoring

0  No Pain 
1‐3  Mild Pain 
4‐6  Moderate pain 
7‐10  severe pain 
 Assessment of pain and Physiological Measures

Instructions :
The observation will be recorded by the Investigator using reliable
instruments
Aim:
Assess the pain Heart rate, Respiratory rate and Blood Pressure before and
after music therapy

Physiological parameters

Pre Test Post Test

No of Post. Op. day

Blood pressure

Blood pressure
Time

Time
Respiration

Respiration
Date

Pain Score
Pain score
Pulse

Pulse

2nd

3rd
 APPENDIX - VII
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APPENDIX - VIII
APPENDIX – IX
 APPENDIX - X

Mechanism of pain.

Tissue damage caused by surgery generates a series of complicated electrical

and chemical events in a patient’s body. Small nerve endings in the tissue conduct

nerve impulses along nerve trunks toward the spinal cord and continue as pain flows

toward brain centers, ending at the cerebral cortex.

The perception of tissue damage as pain is divided into these phases:

 Transduction,
 Transmission,
 Modulation,
 Perception

In transduction the mechanical, chemical, or thermal stimulus causing the

tissue damage results in electrochemical activation of the nerve endings. The tissue

damage stimulates neurotransmitters, which either sensitize the tissue to other stimuli

or cause tissue stimulation directly.

In transmission peripheral sensory nerves transmit impulses to the spinal cord

and from here, by means of neurotransmitters, to the thalamus and on to the cerebral

cortex.

The modulation phase regulates pain in the nervous system.t

The fourth phase in the transmission of pain is perception, which is a subjective

response to the function of neurons transmitting pain (Dahl & Kehlet 2006; Heiskanen

& Karjalainen 2006). Pain stimuli travel to the central nervous system via pain axons

Aδ (delta) and C fibers. Aδ fibers are myelinated and C fibers are unmyelinated

nerves. In Aδ fibers the pain stimulus travels 4 rapidly and produces a sharp pain

sensation in the brain. The pain stimuli transmitted by C fibers are slower than Aδ
fibers and are sensed as a burning or aching pain (Heiskanen & Karjalainen 2006;

Kalso 2002).

GATE CONTROL THEORY MADE UP OF

Melzack and Wall presented the first version of the Gate-control theory. They

postulated that when injury occurs, ‘A’ delta and ‘C’ fibers are stimulated and deliver

impulses to brain via the substantial gelatinosa in the spinal cord, and that this area of

the spinal cord controls the flow of these nociceptive impulses. They suggested that

this control mechanism is influenced by a number of factors, which could inhibit or

facilitate the passage of the pain impulses and used the analogy of a gate being able to

open or close to describe the concept. They caused experimental and clinical evidence

to build their theory and suggested that the ‘gate’ could be closed by mechanical

pressure stimulating ‘A’ beta fiber, descending inhibitory impulses from the brain,

and cognitive control. The theory implies that the nociceptive input is subjected to a

modulating influence before it evokes pain perception and pain will occur if the

nociceptive input exceeds that of the inhibitory mechanisms Using further evidence,

the gate control theory of pain was extended to include a motivational dimension and

proposed that pain had three components:

1. A discriminative sensory component primarily influenced by rapidly

conducting spinal system.

2. A motivational drive and the unpleasant affect characteristic of pain, such as

fear and emotional responses to pain.

3. A cognitive component based on the analysis of the input, past experiences

and the meaning of the pain.

Surgical incision

They acknowledge that every person with pain has a complex,

multidimensional and unique experience. Their experiences are influenced by the

factors such as post-operative pain, pain after ambulation, rest.

Nociceptive Impulses

The post operative pain is transmitted through the nociceptive receptors

situated in the substantial gelatinosa, which in turn gets situated and transmits the pain

impulse, thus the patient experience pain.

Persived Pain Intensity.

The perceived pain intensity is expressed as anger, anxiety and depression

(patient’s subjective feeling). Their influencing factors provoke mood changes which

are expressed as anger, anxiety and depression. Although these three are the

independent components, yet mutually support and feed one another, as well as

enhance pain perceptions.

Music Therapy.

There are three possible ways that music may modify pain (Magill-Levreault,

1993).

1. Affective: Music may alter mood disturbances associated with long term and life

threatening illnesses such as anxiety, depression, fear, anger, and sadness. Music

can lift depressive symptoms, promote relaxation, and thus diminish tension and

anxiety.

2. Cognitive: Associative qualities of music provide a means of distracting attention

away from pain often creating images and carrying a person’s thoughts away from
 the noxious stimuli. Music provides a mechanism to improve patients’ sense of

control.

3. Sensory: Sensory component of music may have effect on sensory component of

pain through counter- stimulation of the afferent fibers.

Diversion

Music therapy, when repeatedly administrated gradually creates diversion,

which in turn relaxes the mind and changes the mood. It can reduce pain intensity,

length of hospital stays and improve patients’ quality of life. Therefore goals of music

therapy range from reduction of psycho physiological stress, pain, anxiety and

isolation to modulation of mood and behavior modification. Music therapy will help

in the activation of ‘C’ fibers, which has caused the inhibition of transmission of pain

impulses.

Patient Opinion.

The patient’s opinion regarding the diversion of pain with the music therapy

can be assessed by opinonnaire, which may be manifested as Interesting- not

interesting, relaxation-no relaxation, effective- not effective, pain reduced- pain not

reduced.
APPENDIX – XI
APPENDIX – XII