780 • AORN JOURNAL • APRIL 2008, VOL 87, NO 4 © AORN, Inc, 2008
The Anxiety- and Pain-Reducing
Effects of Music Interventions:
A Systematic Review
ULRICA NILSSON, RNA, PHD
Nurses face many challenges as
they care for the needs of hospitalized
patients, and they often
have to prioritize physical care over the
patient’s emotional, spiritual, and psychological
needs. Meeting these additional
needs is a challenge. In clinical
practice, music intervention can be a tool
to support these needs by creating an environment
that stimulates and maintains
relaxation, well-being, and comfort. Mu –
sic can be used as a self-management
technique to reduce or control distress.1
This article provides a systematic review
of recent studies describing the clinical
effects of music interventions for hospitalized
patients in perioperative settings.
THE HISTORY OF MUSIC IN HEALTH CARE
Music has been used since ancient
times to influence human health.1 Archaeological
findings show that primitive
man used music as a way to “appease
the gods.”2 In the sixth century,
the Greek philosopher Pythagoras, who
is considered the founder of music therapy
and geometry, believed that music
greatly contributed to health. Pythagoras
prescribed music and a specific diet
to restore and maintain the harmony of
the body and soul.3
In the mid 1800s, Florence Nightingale
recognized the power of music in hospital
wards to aid in the healing proc –
ess for soldiers injured in the Cri mean
War. Nightingale also noted the effects
of different types of music. She observed
that wind instrument pieces
with continuous sound or air generally
had a beneficial effect on patients. She
also observed that instruments that do
not produce continuous sounds had
the opposite effect. Nightingale believed
it was the responsibility of nurses
to control the patient’s environment
in order for healing to take place.1,3-5
After the invention of the phonograph
in the late 1800s, recorded music could be
used in the hospital setting. The most extensive
account of music in general hospitals
appeared during the first half of
the 1900s when health care practitioners
used music in conjunction with anesthesia
and analgesia.6 In 1914, Kane was the
first person to provide intraoperative
music to distract patients from the “horror
of surgery.”7(p1829)
In 1926, Ilsen established the National
Association for Music in Hospitals. Ilsen,
a nurse, advocated for the implementation
of specific musical prescriptions or
treatment regimes. She identified rhythm
as the basic therapeutic element in music.8
In 1949, a group of surgeons studied
the use of music in conjunction with psychosomatic
factors in physical illness.
They performed a series of procedures
MUSICAL INTERVENTIONS have been used in
health care settings to reduce patient pain, anxiety,
and stress, although the exact mechanism of
these therapies is not well understood.
THIS ARTICLE PROVIDES A SYSTEMATIC review
of 42 randomized controlled trials of the effects
of music interventions in perioperative settings.
MUSIC INTERVENTION HAD POSITIVE effects
on reducing patients’ anxiety and pain in approximately
half of the reviewed studies.
FURTHER RESEARCH into music therapy is warranted
in light of the low cost of implementation
and the potential ability of music to reduce perioperative
patient distress. AORN J 87 (April 2008)
780-807. © AORN, Inc, 2008.
ABSTRACT
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782 • AORN JOURNAL
and observed that music had a calming effect on
patients who were normally tense and nervous
and for whom routine medications did not work.9
THE THERAPEUTIC EFFECTS OF MUSIC
Various complex theories, hypotheses, and
assumptions have been proposed regarding
how music works in the health care setting. In
2006, Sacks10 indicated that the power of music
scarcely has been examined, even though significant
advances had been made in the preceding
20 years. Sacks believed that the power
of music goes to the heart of being human.10
In 1990, Thaut11 proposed that music stimuli
have biological effects on human behavior by
engaging specific brain functions involved in
memory, learning, and multiple motivational
and emotional states. The effects of music are
seen in the right hemisphere of the brain; however,
the left hemisphere may play a major role
in the analytical aspects of cerebral interpre –
tation of the music. Auditory perception of
music occurs in the auditory center of the temporal
lobe of the brain, which then signals the
thalamus, midbrain, pons, amygdala, medulla,
and hypothalamus.11
The commonly accepted theory explaining
the pain-, anxiety-, and stress-reducing effects of
music is that music acts as a distracter, focusing
the patient’s attention away from negative stimuli
to something pleasant and encouraging.
Music occupies the patient’s mind with something
familiar and soothing, which allows the
patient to escape into his or her “own world.”
Additionally, patients can focus their awareness
on the music to aid relaxation.3,12-14
It is important to provide perioperative
nurses and managers with evidence that these
interventions help reduce patients’ experience
of unpleasant symptoms and discomfort. In perioperative
settings, patients often are in a transitional
zone between consciousness and sleep.
Many senses are impaired, but the patient’s
sense of hearing still functions.1
This systematic review of the literature,
therefore, was conducted to identify randomized
controlled trials (RCTs) that have assessed
the effect of music interventions on perioperative
patients’ pain and anxiety. The definition
of an RCT is a study in which patients are assigned
to treatment groups or a control group
based on a random or quasi-random method
(eg, using random days, weeks, numbers).
SEARCH STRATEGY METHODS
A search of research articles published between
January 1995 and January 2007 was
performed on the Allied and Complementary
Medicine Database (AMED), the Cumulative
Index to Nursing and Allied Health Literature
(CINAHL), and Medline. Only articles written
in English containing the following search
terms were included:
• music,
• therapy,
• preoperative,
• intraoperative,
• postoperative,
• perioperative,
• surgery,
• anaesthesia,
• anesthesia,
• pain, and
• anxiety.
The search was conducted using terms both
separately and in combination with each other.
The search returned a total of 173 articles,
distributed as follows:
• 13 from AMED,
• 77 from CINAHL, and
• 83 from Medline.
After removing duplicate articles, the researcher
reviewed a total of 69 articles, screening them for
eligibility. Thirteen of the 69 articles were excluded
because they reported the use of live music
performed by a music therapist; music was used
only in combination with other nonpharmacological
methods (eg, guided imagery, massage);
or use of sound instead of music (eg, hemispheric,
binaural sound). Eighteen articles were excluded
because of nonrandomization, lack of
clarity in the methods or results, or because inclusion
and exclusion criteria were not reported.
Five articles were excluded because the study results
were reported in more than one article.
In addition, a manual search was performed
using the reference lists from the retrieved articles.
An additional nine studies were found
through this search, a manual search of relevant
journals, and the researcher’s knowledge
Nilsson APRIL 2008, VOL 87, NO 4
AORN JOURNAL • 785
of the literature and research in this field.
Only RCTs written in English were included.
Additionally, the patient population was
limited to adult patients (ie, older than 17
years); and music interventions were limited
to those performed preoperatively, intraoperatively,
and/or postoperatively. Outcome
measures of the included studies were pain,
anxiety, and stress indicators. The music interventions
in the reviewed articles consisted of
recorded music. This literature search identified
42 relevant RCTs that met the inclusion
criteria (Table 1).
QUALITY ASSESSMENT
The author used a 3-point scale to assess five
main features of the methodological quality of
the 42 studies. These features included
• outcome measure questionnaires, rated
• 2 if validity and reliability has been dem –
onstrated in 90% or more of the outcome
measures,
• 1 if validity and reliability has been dem –
onstrated in 89% or less of the outcome
measures, or
• 0 if validity and reliability was not
demonstrated;
• blinding, rated
• 2 for double-blind studies,
• 1 for single-blind studies, or
• 0 for no blinding;
• concealment of allocation at enrollment,
rated
• 2 for truly randomized allocation,
• 1 for semisecure randomization, or
• 0 for nonsecure randomization or
unclearly demonstrated randomization;
• completeness of follow up, rated
• 2 for 100% follow up or intent-to-treat
analysis,
• 1 for 80% to 90% follow up, or
• 0 for follow up less than 80% or when
information was unclear; and
• sample size calculation, rated
• 2 if a sample size calculation was performed
or
• 0 if a sample size calculation was not
performed.
These criteria for quality assessment were
taken from Rubin and Hotopf’s systematic review
exploring postoperative fatigue;15 however,
the researcher added the criteria “sample
size calculation.” The calculation of sample
size helps maximize the chances of detecting a
statistically and clinically significant difference
between the interventions when a difference
really exists.16 Using this assessment tool, a
total quality score was assigned to each article.
Ratings could range from 0 (ie, the worst quality)
to 10 (ie, the best quality).
For a meta-analysis, the intervention and
the dose of the intervention must be constant.
For the studies included in this review, the
types of music used differed; the duration of
listening time differed (ie, the dose); and the
patients’ care differed. A meta-analysis, therefore,
was not performed. Thus, the studies
were assessed for the quality of their methodology,
and they were analyzed according to
outcome measures.
RESULTS
A total of 42 RCTs were assessed. They varied
in patient demographics and procedural
type, the timing and type of musical inter –
vention used, and the quality measurement
assigned to the RCT by the researcher conducting
this review.
BASELINE CHARACTERISTICS. The 42 RCTs that were
reviewed included 3,936 patients. The number
of patients in these studies ranged from nine to
500. The mean age of the participants ranged
from 34 to 76 years. In 33 of the studies, both
men and women were included. In one study,
only men were included, and in five studies
only women were included. Three studies did
not report the gender of the participants.
Patients in all the studies underwent elective
surgery. The types of surgery included gynecological;
abdominal; ear, nose, and throat; cardiac;
urologic; ophthalmologic; orthopedic; and breast
biopsy. Some studies included combinations of
different types of surgery (eg, major abdominal,
outpatient). Other studies were more precise in
their inclusion criteria, with all included patients
having the same type of surgery (eg, hysterectomy,
septorhinoplasty, inguinal hernia repair,
open-heart surgery, transurethral resection of the
prostate, varicectomy, lithotripsy, cataract surgery,
lumbar disk surgery).
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TABLE 1
Randomized Control Trials That Met Inclusion Criteria
Quality Ages or Type of Intervention
Study score* N mean age surgery period
Allen et al1 4 40 76 Ambulatory Preoperative,
2001 Male: 10 ophthalmic intraoperative,
USA Female: 30 postoperative
Augustin & Hains2 4 42 47 Ambulatory Preoperative
1996 Male: 25
USA Female: 17
Ayoub et al3 8 90 55 Urological with Intraoperative
2005 Male: 77 spinal anesthesia
USA Female: 13
Barnason et al4 8 96 67 Coronary artery Postoperative
1995 Male: 65 bypass graft day two and
USA Female: 31 (CABG) three
Blankfield et al5 3 95 61 CABG Intraoperative
1995 Male: 65 and twice daily
USA Female: 30 postoperative
Broscious6 6 156 66 Open heart Postoperative
1999 Male: 107 before chest
USA Female: 49 tube removal
Cepeda et al7 8 193 41 Extracorporeal shock Intraoperative,
1998 Male: 95 wave lithotripsy preoperative,
Columbia Female: 98 with alfentanil postoperative
patient-controlled
anesthesia
Cooke et al8 7 180 56 Day Preoperative
2005 Male: 90
Australia Female: 90
Cruise et al9 6 121 70 Cataract with Intraoperative
1997 Male: 44 retrobulbar block
Canada Female: 77
Gaberson10 4 46 47 Day, elective Preoperative
1995 Male: 19
USA Female: 27
Good11 3 84 46 Major abdominal Postoperative
1995 Male: 25 days one and
USA Female: 59 two
* The quality score was assigned by this review’s author. The range is from 0 (lowest) to 10 (highest).
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TABLE 1
Randomized Control Trials That Met Inclusion Criteria (continued)
Type of music Delivery Music Participant allocation
intervention method duration per type of intervention
Self-selected from Cassette player Unspecified Music = 20
22 provided with headphones Usual care = 20
types
Self-selected from Cassette player 15 to 30 minutes Music = 21
classical, environmental, with headphones Usual care = 21
New Age, country/
western, easy listening
Self-selected CD player with Throughout Music = 31
headphones procedure White noise = 31
OR noise = 28
Self-selected Cassette player 30 minutes Music = 33
from five soothing with headphones Music video = 29
types Rest period = 34
Specific New Cassette player Throughout Music = 32
Age album, with headphones procedure and Music and suggestion = 34
provided twice daily Control = 29
Self-selected Cassette player 10 minutes Music = 70
from 10 types with headphones White noise = 36
Usual care = 50
Self-selected, Unspecified type of 10 minutes pre- Music = 97
unspecified type player with and postoperative Control = 96
headphones and throughout
procedure
(mean: 40 minutes)
Self-selected from CD player with 30 minutes Music = 60
classical, jazz, country/ headphones Control = 60
western, New Age, easy Usual care = 60
listening, other
Classical with Cassette player Throughout Music = 32
nature sounds, with headphones procedure Suggestion = 30
provided White noise = 29
OR noise = 30
Slow, quiet Cassette player 20 minutes Music = 16
instrumental, with headphones Humor = 15
provided Usual care = 15
Self-selected from Cassette player 60 minutes Music = 21
synthesizer, harp, with headphones Relaxation = 21
piano, orchestral, Music and relaxation = 21
or slow jazz Rest in bed = 21
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TABLE 1
Randomized Control Trials That Met Inclusion Criteria (continued)
Quality Ages or Type of Intervention
Study score N mean age surgery period
Good & Chin12 4 38 41 Major abdominal Postoperative
1998 Male: 3 or gynecologic days one and
USA and Female: 35 two
Taiwan
Good et al13 5 500 45 Major abdominal Postoperative
1999 Male: 87 or gynecologic days one and
USA Female: 413 two
Haun et al14 5 20 38 Breast biopsy Preoperative
2001 Female: 20
USA
Ikonomidou et al15 6 55 34 Gynecologic Preoperative
2004 Female: 55 laparoscopy and post-
Sweden operative
Kliempt et al16 4 76 46 General with Intraoperative
1999 Male: 33 anesthesia
United Female: 43
Kingdom
Koch et al17 4 34 (Phase I) 54 Urologic with Intraoperative
1998 Male: 29 spinal anesthesia
USA Female: 5
43 (Phase II) 54 Lithotripsy Intraoperative
Male: 27
Female: 16
Kwekkeboom18 3 58 53 Noxious, cancer- Preoperative
2003 Male: 18 related and intra-
USA Female: 40 operative
Laurion & Fetzer19 2 84 35 Gynecologic Preoperative,
2003 Female: 84 laparoscopy intraoperative,
USA postoperative
Lee et al20 3 113 51 Noninvasive out- Preoperative
2004 Male: 58 patient with local or
Hong Kong Female: 55 regional anesthesia
Lepage et al21 4 50 38 Ambulatory with Intraoperative
2001 Male: 31 spinal anesthesia
Canada Female: 19
Masuda et al22 5 44 Not Orthopedic Postoperative
2005 (gender not specified
Japan specified)
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TABLE 1
Randomized Control Trials That Met Inclusion Criteria (continued)
Type of music Delivery Music Participant allocation
intervention method duration per type of intervention
Self-selected from Cassette player 15 minutes Music = 16
synthesizer, harp, with headphones Rest in bed = 22
piano, orchestral,
or slow jazz
Self-selected from Cassette player 15 minutes Music = 130
synthesizer, harp, with headphones Relaxation = 130
piano, orchestral, Music and relaxation = 120
or slow jazz Rest in bed = 120
Self-selected Cassette player 20 minutes Music = 10
New Age with headphones Sleep or chat with
family member = 10
Pan flute, CD player with 30 minutes, both Music = 29
provided headphones preoperatively and Control = 26
postoperatively
Classical, Cassette player Throughout Music = 25
provided with headphones procedure Hemispheric sound = 25
Control = 26
Self-selected CD player with Throughout Music = 19
own favorite headphones procedure Regular OR noise = 15
Self-selected CD player with Throughout Music = 21
own favorite headphones procedure Regular OR noise = 22
Self-selected from CD player with 5 to 15 minutes Music = 24
variety offered by headphones preoperatively Distraction = 14
researcher and throughout Rest = 20
procedure
Piano, Cassette player Unspecified Music = 28
provided with headphones Guided imagery = 28
Usual care = 28
Self-selected from CD player with 20 to 40 minutes Music = 58
Eastern, Western, easy headphones Relaxing activities = 55
listening, Chinese pop (eg, reading, television)
Self-selected from CD player with Throughout Music = 25
pop, jazz, classical, headphones procedure Usual care = 25
New Age
Self-selected from Compact disc (CD) 20 minutes Music = 22
classical or Japanese player with Usual care = 22
(gagaku, noh, or enka) headphones
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TABLE 1
Randomized Control Trials That Met Inclusion Criteria (continued)
Quality Ages or Type of Intervention
Study score N mean age surgery period
McCaffrey & Locsin23 1 124 76 Hip and knee Postoperative
2006 Male: 44 three days
USA Female: 80
McRee et al24 5 52 43 General surgery Preoperative
2003 Male: 19 with general, spinal,
USA Female: 33 regional, or local
anesthesia
Miluk-Kolasa et al25 4 100 20 to 60 Varicectomy or Preoperative
1996 Male: 72 laryngological
Poland Female: 28
Mok & Wong26 3 80 18 to 70 Minor with Intraoperative
2003 Male: 15 local anesthesia
Hong Kong Female: 65
Nilsson et al27 9 89 51 Hysterectomy with Intraoperative
2001 Female: 89 general anesthesia
Sweden
Nilsson et al28 8 182 52 Inguinal hernia or Postoperative
2003(a) Male: 132 varicose vein
Sweden Female: 50
Nilsson et al29 8 151 54 Inguinal hernia repair Intraoperative
2003(b) Male: 107 varicose vein, general or postoperative
Sweden Female: 44 anesthesia
Nilsson et al30 9 75 56 Inguinal hernia Intraoperative
2005 Male: 72 repair with general or postoperative
Sweden Female: 3 anesthesia
O’Neill31 4 60 46 Orthopedic Postoperative
2002 (Gender not
United specified)
Kingdom
Sendelbach et al32 2 86 63 CABG or heart Postoperative
2006 Male: 60 valve replacement
USA Female: 26
Shertzer & Keck33 2 87 59 Elective Postoperative
2001 Male: 82
USA Female: 5
Szeto & Yung34 1 9 58 Elective Preoperative
1999 (Gender not
Hong Kong specified)
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TABLE 1
Randomized Control Trials That Met Inclusion Criteria (continued)
Type of music Delivery Music Participant allocation
intervention method duration per type of intervention
Lullaby and self CD player, 1 to 4 hours Music = 62
selected from differing unspecified means daily Usual care = 62
relaxing options of delivery
Piano, CD player with 30 minutes Music = 13
provided headphones Music and massage = 13
Massage = 13
Usual care = 13
Self-selected, Cassette player 60 minutes Music = 50
unspecified type with headphones Left alone = 50
Self-selected from Cassette player Throughout Music = 40
classical, popular, with headphones procedure Usual care = 40
contemporary, Chinese
New Age, Cassette player Throughout Music = 30
provided with headphones procedure Music and suggestions = 31
Control = 28
Soft classical, Cassette player Mean: 117 Music = 62
provided with headphones minutes Music and suggestions = 57
Control = 63 (ie, no music)
New Age, CD player with Throughout Intraoperative music = 51
provided headphones procedure or Postoperative music = 51
60 minutes Control = 49
New Age, CD player with Throughout Intraoperative music = 25
provided headphones procedure or Postoperative music = 25
60 minutes Control = 25
Self-selected, own CD player 120 minutes Music = 30
music or music with headphones Usual care = 30
provided by
researcher
Self-selected from Cassette player 20 minutes for Music = 50
easy listening, classical, with headphones three sessions Rest in bed = 36
or jazz
Mozart and ocean Cassette player 60 minutes Music = 46
music, provided with loud speaker Usual care = 41
Self-selected from Not specified 20 minutes Music = 6
slow rhythmic, either Usual care = 3
Chinese or Western
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TABLE 1
Randomized Control Trials That Met Inclusion Criteria (continued)
Quality Ages or Type of Intervention
Study score N mean age surgery period
Taylor et al35 7 61 39 Hysterectomy Postoperative
1998 Female: 61
USA
Tse et al36 2 57 40 Functional Postoperative
2005 Male: 33 endoscopic sinus
China Female: 24 or tubinectomy
Twiss et al37 5 86 74 CABG or heart Intraoperative
2006 Male: 28 valve replacement and
USA Female: 58 postoperative
Voss et al38 7 61 63 Open heart Postoperative
2004 Male: 39 day one
USA Female: 22
Wang et al39 7 93 43 Unspecified with Preoperative
2002 Male: 56 general or regional
USA Female: 37 anesthesia
Yilmaz et al40 4 98 40 Extracorporeal shock Intraoperative
2003 Male: 61 wave lithotripsy with
Turkey Female: 37 local anesthesia
Yung et al41 4 30 68 Transurethral Preoperative
2002 Male: 30 resection of the
China prostate
Zimmerman et al42 4 96 67 CABG Postoperative for
1996 Male: 65 three days
USA Female: 31
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Type of music Delivery Music Participant allocation
intervention method duration per type of intervention
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Self-selected own Cassette player Unspecified Unspecified to music,
relaxing music with headphones control, and usual care
Self-selected from own Cassette player 30 minutes for Music = 27
music, Chinese, and with headphones five sessions Usual care = 30
Western
Use of six customized CD player with Unspecified Music = 42
music CDs headphones Usual care = 44
Self-selected from Cassette player 30 minutes Music = 19
synthesizer, harp with headphones Rest = 21
piano, orchestral Usual care = 21
or slow jazz
Self-selected own CD player with 30 minutes Music = 48
favorite headphones Control = 45
Self-selected from Unspecified type of Throughout Music = 50
provided relaxing, slow player with procedure Control = 48
rhythm, sedative headphones
Self-selected from Unspecified type of 20 minutes Music = 10
slow rhythmic, either player with Nurse presence = 10
Chinese or Western headphones Usual care = 10
Self-selected, limited Cassette player 30 minutes Music = 32
to country/western, with headphones Music video = 32
instrumental, New Age Rest = 32
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37. Twiss E, Seaver J, McCaffrey R. The effect of music listening on older adults undergoing cardiovascular surgery.
Nurs Crit Care. 2006;11(5):224-231.
38. Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduces anxiety and pain during
chair rest after open-heart surgery. Pain. 2004;112(1-2):197-203.
39. Wang SM, Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth
Analg. 2002;94(6):1489-1494.
40. Yilmaz E, Ozcan S, Basar M, Basar H, Batislam E, Ferhat M. Music decreases anxiety and provides sedation in
extracorporeal shock wave lithotripsy. Urology. 2003;61(2):282-286.
41. Yung PM, Chui-Kam S, French P, Chan TM. A controlled trial of music and pre-operative anxiety in Chinese men
undergoing transurethral resection of the prostate. J Adv Nurs. 2002;39(4):352-359.
42. Zimmerman L, Nieveen J, Barnason S, Schma derer M. The effects of music interventions on postoperative pain and
sleep in coronary artery bypass graft (CABG) patients. Sch Inq Nurs Pract. 1996;10(2):153-174.
Nilsson APRIL 2008, VOL 87, NO 4
AORN JOURNAL • 797
INTERVENTION. The majority of the music interventions
(n = 15) were performed postoperatively.
17-31 In 10 of the studies, interventions
were performed preoperatively,32-41 and in nine
of the studies, interventions were performed
intraoperatively.42-49 Two studies compared intraoperative
and postoperative interventions.50,51
The remaining five studies were performed
with a combination of interventions:
• preoperative, intraoperative, and post –
operative;52-54
• preoperative and intraoperative;55
• preoperative and postoperative;56 and
• intraoperative and postoperative.57,58
The type of music was soothing (ie, 60 to 80
beats per minute), and in the majority of the
studies (n = 29), self-selected music was used.
This included the patient’s own favorite music
or music chosen from a selected list of musical
genres (eg, classical, New Age, jazz). In the
other 15 studies, one specific genre of music
was provided by the researchers. This included
New Age,48-51,58 classical,24,26,43,44 slow instrumental,
34 piano,37,54 and pan flute.56
The duration of preoperative or postoperative
listening time lasted from five minutes to four
hours. In the majority of the studies, the listening
time lasted from 15 to 30 minutes.17,20-22,27,29-35,37,39-41,56
Intraoperatively, music was used during the en –
tire period, beginning at the start of the procedure.
42-51,58 Four of the studies did not report the
duration of the listening time.28,53,54,57 In only one
study was the music played using loud speakers.
26 Two of the studies did not report whether
headphones or loudspeakers were used.23,39 All of
the remaining studies (n = 39) used headphones
to provide music to the patients.
QUALITY. No single included study was assessed
to have the maximum quality score of
10 points. The total quality scores ranged from
1 to 9, with a mean score of 6. Two studies
scored 9 points,48,51 and five studies scored 8
points.17,24,42,50,52 All seven of these studies were
published between 1995 and 2005. In 11 of the
reviewed studies (ie, 26%), the quality was insufficient,
meaning that the quality assessment
method used in this review scored the studies
three points or less.19,23,26,27,29,36,39,47,54,55,58 These studies
were published between 1995 and 2006.
A majority of the included studies (n = 30) had
demonstrated validity and reliability measures in
90% of their outcomes.17-21,23-26, 28,30-36,38,40-43,46-48,50,51,55-57 In
the studies that demonstrated less or no validity
and reliability, the most common reason was that
the studies did not report the validity and reliability
of the equipment used to measure blood
pressure, heart rate, and respiratory rate.
Nine of the studies24,28,33,40, 43,49-52 were single
blind—that is, all patients used headphones,
and the patients in the control group listened
to a blank tape. The patients, thus, were blinded
to their group assignment. Two studies
were double blind,42,48 in that neither the patient
nor the researcher knew the group assignment
(ie, control group, music inter –
vention). In these studies, the participants
received the music intraoperatively while they
were under general anesthesia. The remaining
studies had no blinding, with the patients in
the control groups receiving usual care or rest.
Only eight studies17,24,44,45,48,50-52 reported truly
random allocation. Semisecure allocation (eg,
flipping a coin, drawing a slip of paper) was reported
in five studies.18,26,35,43,57 In the remaining
21 studies, the randomization method was not
explicit or was nonsecure (eg, patients were assigned
to groups on random days or weeks).
One hundred percent of follow up or intentionto-
treat analysis was reported in 22 of the studies.
17,25,28-33,35-38,40-43,46,49,51-54 Twelve studies reported
80% to 90% follow up,18-21,24,44,45,48,50,55,56,58 and in the
rest of the studies, there was 79% or less follow
up or the information was unclear.22,23,26,27,34,39,47,57
Sample size calculation was reported in 13 of the
included studies.17,18,24,28,30,34,40,42,48,50-52,56
OUTCOME MEASURES
Various outcome measures were recorded in
the articles reviewed. These included patient
anxiety, pain, vital signs, and blood sample indicators
(Table 2).
ANXIETY. A total of 24 studies evaluated the effect
of music on patient anxiety.17,19,24,27,30,32-37,39-43,45-47,49-51,55,57
The most common tool used to measure anxiety
was the State-Trait Anxiety Inventory
(STAI), which was used in 19 of the 24 stud –
ies.17,19,24,27,32,33,35-37,39-43,46,47,49,55,57 A numeric rating
scale was used in three studies,17,50,51 and a
visual analog scale was used in four studies.
30,34,43,46 Perceived control over anxiety was
APRIL 2008, VOL 87, NO 4 Nilsson
798 • AORN JOURNAL
TABLE 2
Summary of Significance of Measurements
in the Included Studies
Anxiety Sedative Pain Analgesic
Source Year score use score use
Allen et al1 2001
Augustin & Hains2 1996 No
Ayoub et al3 2005 No Yes
Barnason et al4 1995 No
Blankfield et al5 1995 No
Broscious6 1999 No
Cepeda et al7 1998 No
Cooke et al8 2005 Yes
Cruise et al9 1997 No
Gaberson10 1995 No
Good11 1995 No No No
Good & Chin12 1998 Yes
Good et al13 1999 Yes No
Haun et al14 2001 Yes
Ikonomidou et al15 2004 No Yes
Kliempt et al16 1999 Yes
Koch et al17 1998 No Yes No Yes
Kwekkeboom18 2003 No No
Laurion & Fetzer19 2003 Yes No
Lee et al20 2004 Yes
Lepage et al21 2001 No Yes
Masuda et al22 2005 Yes
McCaffrey & Locsin23 2006 Yes Yes
McRee et al24 2003 No No
Miluk-Kolasa et al25 1996
Mok & Wong26 2003 Yes
Nilsson et al27 2001 Yes No
Nilsson et al28 2003(a) No Yes No
Nilsson et al29 2003(b) Yes Yes Yes
Nilsson et al30 2005 Yes Yes Yes
O’Neill31 2002
Sendelbach et al32 2006 Yes Yes
Shertzer & Keck33 2001 No
Szeto & Yung34 1999 Yes
Taylor et al35 1998 No No
Tse et al36 2005 Yes
Twiss et al37 2006 Yes
Voss et al38 2004 Yes Yes
Nilsson APRIL 2008, VOL 87, NO 4
AORN JOURNAL • 799
TABLE 2
Summary of Significance of Measurements
in the Included Studies (continued)
Blood Heart Respiratory Blood Other stress or
Pressure rate rate levels pain indicators
Yes Yes
No Yes No
No No No
No No No
No No
Side effects/quality
of analgesia: No
Yes
No No Yes
No No Yes
No No
No No No
No No No
No No Skin temperature: No
Blood flow: No
No No Prolactin: No
Cortisol: No
Yes Yes Glucose: Yes Skin temperature: Yes
Cardiac output: Yes
Yes No
No
Cortisol: Yes
Glucose: No
Immunoglobulin A: No
No Yes Yes
No No
No No
Yes Yes
APRIL 2008, VOL 87, NO 4 Nilsson
800 • AORN JOURNAL
TABLE 2
Summary of Significance of Measurements
in the Included Studies (continued)
Anxiety Sedative Pain Analgesic
Source Year score use score use
1. Allen K, Golden LH, Izzo JL Jr, et al. Normalization of hypertensive responses during ambulatory surgical stress by
perioperative music. Psychosom Med. 2001;63(3):487-492.
2. Augustin P, Hains AA. Effect of music on ambulatory surgery patients’ preoperative anxiety. AORN J. 1996;63
(4):750-758.
3. Ayoub CM, Rizk LB, Yaacoub CI, Gaal D, Kain ZN. Music and ambient operating room noise in patients undergoing
spinal anesthesia. Anesth Analg. 2005;100(5):1316-1319.
4. Barnason S, Zimmerman L, Nieveen J. The effects of music interventions on anxiety in the patient after coronary
artery bypass grafting. Heart Lung. 1995;24(2):124-132.
5. Blankfield RP, Zyzanski SJ, Flocke SA, Alemagno S, Scheurman K. Taped therapeutic suggestions and taped music as
adjuncts in the care of coronary-artery-bypass patients. Am J Clin Hypn. 1995;37(3):32-42.
6. Broscious SK. Music: an intervention for pain during chest tube removal after open heart surgery. Am J Crit Care.
1999;8(6):410-415.
7. Cepeda MS, Diaz JE, Hernandez V, Daza E, Carr DB. Music does not reduce alfentanil requirement during patientcontrolled
analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones. J Pain Symptom Manage.
1998;16(6):382-387.
8. Cooke M, Chaboyer W, Schluter P, Hiratos M. The effect of music on preoperative anxiety in day surgery. J Adv
Nurs. 2005;52(1):47-55.
9. Cruise CJ, Chung F, Yogendran S, Little D. Music increases satisfaction in elderly outpatients undergoing
cataract surgery. Can J Anaesth. 1997;44(1):43-48.
10. Gaberson KB. The effect of humorous and musical distraction on preoperative anxiety. AORN J. 1995;
62(5):784-791.
11. Good M. A comparison of the effects of jaw relaxation and music on postoperative pain. Nurs Res. 1995;44(1):52-57.
12. Good M, Chin CC. The effects of Western music on postoperative pain in Taiwan. Kaohsiung J Med Sci. 1998;14
(2):94-103.
13. Good M, Stanton-Hicks M, Grass JA, et al. Relief of postoperative pain with jaw relaxation, music and their combination.
Pain. 1999;81(1-2):163-172.
14. Haun M, Mainous RO, Looney SW. Effect of music on anxiety of women awaiting breast biopsy. Behav Med.
2001;27(3):127-132.
15. Ikonomidou E, Rehnström A, Naesh O. Effect of music on vital signs and postoperative pain. AORN J. 2004;80
(2):269-278.
16. Kliempt P, Ruta D, Ogston S, Landeck A, Martay K. Hemispheric-synchronisation during anaesthesia: a
double-blind randomised trial using audiotapes for intra-operative nociception control. Anaesthesia. 1999;
54(8):769-773.
17. Koch ME, Kain ZN, Ayoub C, Rosenbaum SH. The sedative and analgesic sparing effect of music. Anesthesiology.
1998;89(2):300-306.
18. Kwekkeboom KL. Music versus distraction for procedural pain and anxiety in patients with cancer. Oncol Nurs
Forum. 2003;30(3):433-440.
19. Laurion S, Fetzer SJ. The effect of two nursing interventions on the postoperative outcomes of gynecologic
laparoscopic patients. J Perianesth Nurs. 2003;18(4):254-261.
20. Lee D, Henderson A, Shum D. The effect of music on preprocedure anxiety in Hong Kong Chinese day patients.
J Clin Nurs. 2004;13(3):297-303.
21. Lepage C, Drolet P, Girard M, Grenier Y, DeGagné R. Music decreases sedative requirements during spinal
Wang et al39 2002 Yes
Yilmaz et al40 2003 Yes No Yes
Yung et al41 2002 No
Zimmerman et al42 1996 Yes
Nilsson APRIL 2008, VOL 87, NO 4
AORN JOURNAL • 801
TABLE 2
Summary of Significance of Measurements
in the Included Studies (continued)
Blood Heart Respiratory Blood Other stress or
Pressure rate rate levels pain indicators
anesthesia. Anesth Analg. 2001;93(4):912-916.
22. Masuda T, Miyamoto K, Shimizu K. Effects of music listening on elderly orthopaedic patients during postoperative
bed rest. Nord J Music Ther. 2005;14(1):4-14.
23. McCaffrey R, Locsin R. The effect of music on pain and acute confusion in older adults undergoing hip and knee
surgery. Holist Nurs Pract. 2006;20(5):218-226.
24. McRee LD, Noble S, Pasvogel A. Using massage and music therapy to improve postoperative outcomes. AORN J.
2003;78(3):433-447.
25. Miluk-Kolasa B, Matejek M, Stupnicki R. The effects of music listening on changes in selected phy siological
parameters in adult pre-surgical patients. J Music Ther. 1996;33(3):208.
26. Mok E, Wong KY. Effects of music on patient anxiety. AORN J. 2003;77(2):396-410.
27. Nilsson U, Rawal N, Uneståhl LE, Zetterberg C, Unosson M. Improved recovery after music and therapeutic
suggestions during general anaesthesia: a double-blind randomised controlled trial. Acta Anaesthesiol Scand. 2001;45
(7):812-817.
28. Nilsson U, Rawal N, Enqvist B, Unosson M. Analgesia following music and therapeutic suggestions in the PACU in
ambulatory surgery; a randomized controlled trial. Acta Anaesthesiol Scand. 2003;47(3):278-283.
29. Nilsson U, Rawal N, Unosson M. A comparison of intra-operative or postoperative exposure to music—a controlled
trial of the effects on postoperative pain. Anaesthesia. 2003;58(7):699-703.
30. Nilsson U, Unosson M, Rawal N. Stress reduction and analgesia in patients exposed to calming music
postoperatively: a randomized controlled trial. Eur J Anaesthesiol. 2005;22(2):96-102.
31. O’Neill O. The efficacy of music therapy on patient recovery in the post-anaesthetic care unit. J Adv Perioper Care.
2002;1(1):19-26.
32. Sendelbach SE, Halm MA, Doran KA, Miller EH, Gaillard P. Effects of music therapy on physiological and psychological
outcomes for patients undergoing cardiac surgery. J Cardiovasc Nurs. 2006;21(3):194-200.
33. Shertzer KE, Keck JF. Music and the PACU environment. J Perianesth Nurs. 2001;16(21):90-102.
34. Szeto CK, Yung PM. Introducing a music programme to reduce preoperative anxiety. Br J Theatre Nurs. 1999;9
(10):455-459.
35. Taylor LK, Kuttler KL, Parks TA, Milton D. The effect of music in the postanesthesia care unit on pain levels in
women who have had abdominal hysterectomies. J Perianesth Nurs. 1998;13(2):88-94.
36. Tse MM, Chan MF, Benzie IF. The effect of music therapy on postoperative pain, heart rate, systolic blood pressures
and analgesic use following nasal surgery. J Pain Palliat Care Pharmacother. 2005;19(3):21-29.
37. Twiss E, Seaver J, McCaffrey R. The effect of music listening on older adults undergoing cardiovascular surgery.
Nurs Crit Care. 2006;11(5):224-231.
38. Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduces anxiety and pain during
chair rest after open-heart surgery. Pain. 2004;112(1-2):197-203.
39. Wang SM, Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth
Analg. 2002;94(6):1489-1494.
40. Yilmaz E, Ozcan S, Basar M, Basar H, Batislam E, Ferhat M. Music decreases anxiety and provides sedation in
extracorporeal shock wave lithotripsy. Urology. 2003;61(2):282-286.
41. Yung PM, Chui-Kam S, French P, Chan TM. A controlled trial of music and pre-operative anxiety in Chinese men
undergoing transurethral resection of the prostate. J Adv Nurs. 2002;39(4):352-359.
42. Zimmerman L, Nieveen J, Barnason S, Schma derer M. The effects of music interventions on postoperative pain and
sleep in coronary artery bypass graft (CABG) patients. Sch Inq Nurs Pract. 1996;10(2):153-174.
No No Cortisol: No Electrodermal
Catecholamine: No activity: No
Yes Yes
No No
APRIL 2008, VOL 87, NO 4 Nilsson
measured in one study,55 and the Observer’s
Assessment of Alertness/Sedation was used
in one study.49
In 12 of the 24 studies (50%), the music
intervention significantly reduced anxiety
scores.27,30,33,35,36,39,40,47,49-51,57 Sedative use also was
reported in three stud ies as a measurement of
anxiety,42,45,46 and in all three of these studies
the sedative requirement was significantly less
for pa tients who listened to music.
PAIN. Twenty-two of the studies evaluated the
effect of music on pain.18-24,26-31,45,48-52,54-56 The visual
analog scale, the most commonly used tool to
measure pain, was used in 12 studies.19-24,30,45,48,49,54,56
Other instruments were used to measure pain,
including a numeric rating scale,18,23,26-28,50-52,55 the
McGill Pain Questionnaire,31 and a verbal rating
scale.29,31 In 13 of the 22 trials (59%), music intervention
was shown to have a significant painreducing
effect, reflected by decreased pain
scores.20-24,27,29-31,48,50,51,54
In 15 studies, analgesic use also was measured
as an outcome of pain.19,21,23,24,28,37,44,45,48-51,54,56,58 In sev –
en of these studies (47%), the music intervention
resulted in a significant decrease in the
use of analgesics.23,44,45,49-51,56 The quality of analgesia
and side effects were assessed in one
study52 without any significant effects.
VITAL SIGNS. In 24 of the 42 studies (57%), the
impact of music on a patient’s vital signs was
evalu ated.17,18,22,24,25,27,29,32,35-43,45-47,49,51,53,56 In 22 of
these studies, the effect of music on blood
pressure was measured,17,18,22,25,27,29,32,35-43,45-47,49,53,56
and heart rate also was measured in 22 of the
studies.17,18,22,24,25,27,29,32,35-42,45-47,49,53,56 Eight studies
measured patients’ respiratory rate,17,25,32,35,36,42,46,56
three studies assessed patients’ oxygen saturation,
24,45,49 two studies evaluated patients’ skin
temperatures,22,38 one study measured patients’
blood flow,22 one study measured cardiac output,
38 and one study measured patients’ electrodermal
activity as a vital sign outcome.40 In
six of the 22 studies (27%), the music intervention
groups had significantly reduced heart
rates,25,29,32,38,47,53 and in six studies (27%), a significant
decrease in blood pressure was reported.
29,38,43,47,49,53 A significant decrease in respiratory
rate was reported in three of eight studies
(38%).25,35,56 Significantly improved oxygen saturation
was noted in two of three studies,24,49 and
increased skin temperature and cardiac output
was noted in one study.38
Four studies evaluated the effect of music
on patient stress by measuring various blood
indicators.37,38,40,51 Cortisol was the most commonly
measured stress indicator,37,40,51 and one
study reported a significant reduction in blood
cortisol levels.51 Other stress indicators included
blood glucose,38,51 prolactin,37 and catechol –
amine.40 One study reported a significant reduction
in blood glucose.38
DISCUSSION
Interventions to decrease preoperative anxiety
include not only anxiolytic medications but
also methods for distraction such as music.59 It
also has been reported that patients’ postoperative
recovery includes, among other things,
regaining control over physical and psychological
functions such as pain or anxiety.60
This systematic review shows that music intervention
can have an effect on reducing patient
anxiety and pain in the perioperative setting.
This was demonstrated in approximately 50% of
the outcomes in the studies included in this review.
In quantitative measures, music intervention
was found to reduce the use of sedatives
and analgesics. Some minor but still significant
effects of music interventions were documented
in the reduction of heart rate, blood pressure,
respiratory rate, and reduced blood cortisol levels.
Bernadi et al61 discovered that breathing frequency,
heart rate, and blood pressure were increased
when patients listened to music, and this
increase was proportional to the tempo of the
music. More interesting, however, was that two
minutes of silence randomly interspersed between
the different styles and tempos of music
produced a decrease in respiratory rate, heart
rate, and blood pressures below baseline levels.61
Perhaps music functions more as a “driving
input,” and therefore, the effects of music with a
slower tempo on a patient’s vital signs are minor.
Instead, music with a slower tempo might be
more of a distracter from the patients’ psychological
and physiological experiences such as
pain and anxiety.
In a study on experimentally induced cold
pressor pain (ie, simulated pain created by immersing
a patient’s hand and forearm in ice-cold
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AORN JOURNAL • 803
water), the results indicated that the patients’
preferred music distracted their attention from
pain and helped provide control over it. While
listening to music, the meaning of the negative
sensation can be altered, and the patient gains a
sense of autonomy and an ability to cope.62 The
positive effects of music intervention has been
likened to patient-controlled analgesia,13 and
music could be called “audioanalgesia,” “audioanxiolytic,”
or “audiorelaxation.”
TYPES OF MUSIC. The genre and the duration of
the soothing music did not seem to influence
the effectiveness of music intervention. These
results are confirmed both by a review that
explored the use of music and its effect on anxiety
during short waiting periods63 and a
Cochrane review that explored the effects of
music on pain.64 Although patients’ selection of
the type of music has been advocated by
some,3,19-21 the Cochrane review found that the
positive effect of music was similar in studies
in which patients selected the type of music
and those in which patients did not choose the
type of music.64 It appears that the tempo of
the music is the most important factor, with
slow and flowing music with 60 to 80 beats per
minute having positive outcomes on relaxation
and pain relief. It has been suggested in the literature
that music used therapeutically should
• be nonlyrical,
• consist predominantly of low tones,
• comprise mostly strings with minimal brass
or percussion,1 and
• have a maximum volume level at 60 dB.65
FUTURE RESEARCH
It should be noted that the music used in the
investigations reviewed in this article was not
developed or designed for the treatment of patients
in the health care setting. Based on this
review, it is not possible to determine whether
the use of specially designed music would further
improve the beneficial effects of the music
intervention for these patients. Similarly, documentation
concerning music’s effects on patients
related to the correct dosage (eg, volume,
time period, choice of sound source) is very
limited. Future research should evaluate the effects
of specially composed music that is designed
for this specific setting or for individual
patients or patient groups. Likewise, the differences
in the effect of music interventions related
to patient gender, age, and ethnicity should
be evaluated by future studies.
In the majority of the included studies, headphones
were used. The use of headphones has
been advocated along with an uninterrupted
music sound source.1 Music interventions delivered
using loudspeakers suspended from the
ceiling14 was shown to block unpleasant environmental
sounds and make patients feel more
relaxed. A new challenge would be to study
whether there is any benefit to patients of
using an audio pillow to provide the music
therapy. An audio pillow could provide an adjustable,
patient-focused sound environment
without shutting out the external world. It also
would enable patients to rest in any position
without the inconvenience of wearing headphones.
It should be noted that the application
of the present knowledge related to the use of
music interventions in the health care setting
hinges on an effective implementation strategy
in practical patient care.
LIMITATIONS
For this review, only articles published in
English were included. This may have created
some bias concerning the conclusions (ie, a language
bias), as some music intervention research
has been published in other languages.
Another potential bias of this review is that
Recommendations for
Music Interventions in
Clinical Practice
• Slow and flowing music, approximately 60 to
80 beats per minute
• Nonlyrical
• Maximum volume level at 60 dB
• Patient’s own choice, with guidance
• Suitable equipment chosen for the specific
situation
• A minimum duration of 30 minutes in length
• Measurement, follow up, and documentation
of the effects
APRIL 2008, VOL 87, NO 4 Nilsson
some research has not been published because of
nonsignificant results (ie, a publication bias).16
In 11 of the 42 reviewed studies, the quality
of the study was insufficient (ie, the study
scored 3 points or less on the quality assessment
scale). Some concerns included that there
was no sample size calculation, the description
of the random assignment or study dropouts
was not explicit, or a semisecure randomization
or no blinding was used. Some of the
studies used nonvalidated questionnaires to
assess the effect of the music intervention.
Others did not report the validity and reliability
of the equipment used to measure vital
signs (eg, cardiovascular monitoring, standard
practice). In a review of music interventions
during short-term waiting periods before surgery,
Cooke et al63 came to the conclusion that
some of the included studies (n = 12) had a
number of methodological limitations. In the
Cepada et al Cochrane review of music for
pain relief,64 half of the included studies were
of low quality. The quality appraisal used by
Cepada et al was similar to the one used in
this study, although Cepada et al did not consider
the validation of the questionnaires and
sample size calculation.64
THE BENEFITS OF REVIEWING RCTS
Using only RCTs helps protect against problems
with selection bias and strengthens internal
validity.66 In studies that are not randomized,
it has been shown that results can be
overestimated by up to 40%, and in unblinded
studies, the treatment effects may be overestimated
by approximately 17%.67 In 11 of the 42
studies included in this review, headphones
were used in the control group. In nine of the
42, the design was single blind. In 31 of the
studies, group selection of the patients was
performed without any blinding.
When using RCT to evaluate the effectiveness
of an intervention, it is important to move
beyond the research design and evaluate the
intervention in terms of three specific dimensions:
whether the intervention works, can be
implemented, and fulfills the need of consumers.
68 The results of this review show that
perioperative music intervention works and
has multiple, desirable clinical effects, primarily
in the reduction of pain, anxiety, and stress.
It also has been suggested that
• music intervention is easy to implement,
• patients enjoy it,1-4,12,14 and
• patients can use music as a self-management
technique for distraction or escapism.69
In the review presented here, the quality assessment
was adapted from Rubin and Hotopf15
with the addition of the criterion “sample size
calculation.” Calculating the sample size helps
maximize the chances of detecting a statistically
and clinically significant difference between interventions
when a difference really exists.16,66
The Consolidated Standard of Reporting Trials
(CONSORT), which documents a set of recommendations
for the reporting of clinical trials,
also identifies that the method for determining
sample size should be detailed in publications.70
It is notable that there was no relationship
between the year of publication and the determined
quality level of the studies. Future RCTs
on music must maintain high quality standards.
This can be ensured by following the
CONSORT statement, which includes a flow
diagram that can be used to identify the appropriate
number of participants
• eligible for the study;
• excluded from the study,
• randomized;
• analyzed;
• assigned, but who did not actually receive
the intervention; and
• lost to follow-up.
This statement also recommends providing
specific details about blinding.70
IMPLICATIONS FOR NURSING
The effect of music on pain and stress for
surgical patients is not well understood. A
number of methodological limitations are
evident in the reviewed research. Further research
and research of higher quality is needed
on the ability of music to affect patients’
perioperative pain, anxiety, and stress. It is
recommended that elements of the CONSORT
statement be included in any future research
in this area.
It is important to provide information on
evidence-based interventions to perioperative
nurses and managers. In clinical practice, it
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Nilsson APRIL 2008, VOL 87, NO 4
AORN JOURNAL • 805
also is important to meet the needs of patients
by incorporating effective methods to reduce
patients’ anxiety and discomfort. Music inter –
vention may be a useful method to reduce patients’
experiences of unpleasant symptoms
and discomfort. During perioperative care,
soothing and relaxing music can be used as
audioanalgesia, audioanxiolytic, or audio –
relaxation as an integral part of the multimodal
regimen administered to patients. Providing
music to patients is an inexpensive technique
that does not require extra staff members or expensive
equipment. Music intervention can
help maximize efforts to promote patient comfort
and relaxation as well as reduce or control
perioperative patient distress.
Acknowledgement: This study was supported by
the Research Committee of Örebro County Council,
Örebro, Sweden. The author thanks Per Thorgaard,
MD, chief physician, Department of Anaesthesia
and Intensive Care, Aalborg Sygehus, Aarhus University
Hospital, Northern Jutland, Denmark, for
his assistance with the review of the manuscript.
Editor’s notes: AMED is a registered trademark of
the British Library, London, England. CINAHL,
Cumulative Index to Nursing and Allied Health
Literature, is a registered trademark of EBSCO Industries,
Birmingham, AL. MEDLINE is a registered
trademark of the US National Library of Medicine’s
Medical Literature Analysis and Retrieval System,
Bethesda, MD.
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AORN JOURNAL • 807
Ulrica Nilsson, RNA, PhD, is an assistant
professor at the Centre for Health Care Sciences
and at the Department of Anesthesiology
and Intensive Care, Örebro University
Hospital, Örebro, Sweden.
Adults who do not get recommended vaccinations
leave themselves vulnerable to significant illness
and possibly even death, according to a January 23,
2008, news release from the National Foundation
for Infectious Diseases, Bethesda, Maryland. Routine
immunization of children in the United States
has saved many lives and prevented disease, however,
new data from a Centers for Disease Control and
Prevention survey indicate that many adults are not
taking advantage of advancements in adult disease
prevention.
Immunization is recommended for adults to protect
against chickenpox, diphtheria, hepatitis A and
B, human papillomavirus/cervical cancer, influenza,
measles, meningococcal disease, mumps, pertussis,
pneumococcal disease, rubella, shingles, and tetanus.
Deaths and illnesses associated with these diseases
are largely avoidable with vaccination.
In another recent survey, only 3% to 18% of
adults were able to identify adult-specific vaccinations.
The only exception was the influenza vaccination,
which was named by nearly half of the respondents.
Half of those surveyed also stated that
they are not concerned about whether they or another
adult family member will contract a vaccinepreventable
disease.
The adult vaccination issue represents a national
public health crisis. The consequences have far reaching
ramifications for individuals, families, and the
country as a whole. Though challenges exist in increasing
immunization rates and awareness, experts continue
to urge the integration of adult vaccinations into
routine care to save lives and reduce needless illness.
New data show unacceptably low adult immunization
rates and that adults unaware of infectious disease threat
[news release]. Washington, DC: National Foundation for
Infectious Diseases; January 23, 2008.
Routine Adult Vaccinations Reduce Threat of Disease
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