Table of Contents
Nurses have a profound impact on all aspects of a patient’s hospital stay. Unfortunately our youngest of patients experience the same undesirable events as hospitalized adults. Pet therapy is the use of canines to serve as a distraction for pediatric distress and pain before, during, and after procedures (Vagnoli et al., 2015). Music therapy is another complemented or alternative intervention that can be used in the pediatric hospitalized population (Nguyen, Nilsson, Hellstrom, & Bengtson, 2010). Both of these nonpharmacological interventions serve a significance importance to nursing because they are safe, quick, and effective in application to the clinical setting (Sobo, Eng, & Krich, 2006). The purpose of this paper is to synthesize the effect of music as compared to pet therapy on pain outcomes for hospitalized pediatric patients.
Method
Search Strategy
Articles for this paper were found through the resources provided through Baylor library services. The database, Cumulative Index of Nursing and Allied Health Literature (CINAHL) was used to find the articles. Once in the database, key words such as “pediatric, pain, music, canine, pet, therapy”, were used to narrow results. After articles per the category were found, modified filters were applied: English language, scholarly (peer reviewed), all child, all sex, and publication 2008 to 2018. Some articles did include “reviews”, which were to be excluded for this assignment. However, these types of articles served as an asset to gaining information on the two categories of music therapy and pet therapy- to further guide the search for articles. The article “Canine Visitation (Pet) Therapy” is an article from the year 2006. This article falls out of the time frame that is suggested when conducting a review such as this. However, due to the scarcity of articles that fit this topic and its fitting criteria, this article will still be used in this paper. This article provides strong evidence that is presented in a mixed method study format- therefore enhancing the findings for this topic.
Results
Synthesis of Findings
An overview of the five selected studies, as stated above, is provided in Table 1. Within the five articles, different perspectives, methods, variables, and cultural differences were presented. All five articles had an experimental group and a control group. The experimental group experienced the pet therapy or the music therapy, following the respective article. The control group did not receive either therapeutic intervention.
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A consistent finding throughout the three music therapy studies was the ability for children to better cope with evidence of less distress (Sundar et al., 2016). Whether the clinical setting was in the Emergency Department, Oncology unit, or outpatient setting- there was a positive correlational result in the findings. Each article presented a child that underwent a procedure involving a needle: intravenous insertion, lumbar puncture, and immunizations. In all experimental groups, pain was diminished. Specifically, in the Lumbar puncture study, children with music had a shift in their emotional distress- from fears of dying to control and less pain. (Nguyen et al., 2010). Now, while children in the Emergency Room may not have the same fear of dying, it was shown in the study that music redirected attention away from the stressor or the pain.
In the two pet therapy studies it was found to be true that canine visitation therapy can hold a promise of a valuable addition to pediatric patients in regard to pain management (Sobo et al., 2006). Both of these studies use the Faces scale to measure the child’s pain before and after the painful procedure. Both were significantly rated lower within the experimental group. Something unique is found within the discussion section of both articles, is that pet therapy induced a feeling of well being leading to engagement and feelings of home and pet companionship (Sobo et al., 2006). Dogs provide distraction for a child that is tangible, something they can control. The importance of the realness of the pets was expressed by a handful of children (Vagnoli et al., 2015).
Pet therapy and music therapy interventions both resulted in the theme of distraction (Young, Griffin, Phillips, & Stanley, 2010). Distraction was noticed from all perspectives: the patient, parent, and the health care providers. Another aid to the success of the studies was the aspect of control in both interventions: control to determine the degree of interaction with the dog and control to determine what music to listen to. Whether it was a study that used the Wong Baker scale, the Modified Behavior Pain Scale, or even a study that was conducted in India, Italy, or the United States- music therapy and pet therapy served patients well during invasive procedures.
Best Supporting Evidence
The article that best supports nursing interventions is “Music Therapy to Reduce Pain and Anxiety in Children With Cancer Undergoing Lumbar Puncture: A Randomized Clinical Trial”. This article includes many critical elements to a feasible research study. This article takes a mixed method approach, examining both quantitative and qualitative data. The experimental and control groups were defined clearly: experimental group received music and the control group did not (Nguyen et al., 2010). Participants were randomly assigned to the groups by picking an opaque piece of paper that stated “music” or “no music” (Nguyen et al., 2010).
Neither the researcher nor the provider knew who belonged to which group, which assured anonymity (Nguyen et al., 2010). The open-ended interview questions, supporting the qualitative collection were recorded verbatim- increasing validity. After the interviews were analyzed, themes were coded into subcategories (Grove, 2018). The limiting factors, such as the discomfort in positioning, were respectfully acknowledged and minimized, as able (Nguyen et al., 2010). Appropriate and defined measurement tools were presented in the methods section of the article.
This study effectively provided information for how nurses can implement the nonpharmacological intervention of music therapy. From the beginning, the gap in knowledge was stated- and properly addressed throughout the study (Grove, 2018). Nurse’s level of education is a strong factor in nonpharmacological pain management- and a lack of that can lead to improper pain management (Nguyen et al., 2010). All parts of the research report could be plainly identified. This article provided a launching standpoint for health care providers to care for patients in regards to pain management. The results were clearly stated, leaving the reader without questions or concerns of missing information from the study (Grove, 2018). This study was also approved by the Ethic Committee of NHP and complied with the Helsinki Declaration (Nguyen et al., 2010).
Discussion
All of the studies analyzed in this paper provided the significance of both pet and music interventions, and all provided platforms for nurses to incorporate the findings into clinical practice. The music therapy studies were completed with the use of iPods or live music- some received funding and some did not. Nurses can take these findings and apply music therapy to their unit. Especially in the culture that we live in today, most parents have phones that their children know how to use and most adolescents have a phone of their own. Nurses can use this to their advantage by educating about this nonpharmacological intervention, that does not require a doctor’s order.
This not only would eliminate some of the financial cost that can come with supplying electronics- but it can also eliminate time in locating and reserving an electronic for a specific patient. There are future opportunities for research as evidenced by the Lumbar Puncture article. Music therapy was the only method of pain control, but for further improved results it is probable that music medicine could be combined with pharmacological interventions in the Lumbar Puncture setting (Nguyen et al., 2010). I also believe that, in the future, there will be opportunities for virtual reality to be an area for research to explore.
In regards to the pet therapy articles, fear, anxiety, and pain were all reduced with the presence of a dog (Vagnoli et al., 2015). Due to the benefit of this triad nurses can use this for a multitude of clinical situations: venipuncture, new diagnoses, to just being admitted. The value of this intervention in regards to nurse interventions is the quick time, effectiveness, and safety of this bedside intervention. Nurses can advocate for their patients to be visited by the pet therapy staff- again, this intervention does not require a doctor’s order. An opportunity for future research, and the only question I was left with was, would be to replicate the areas of music therapy with pet therapy. For instance, bringing a dog into the Emergency Department to provide distraction during the wide variety of medical interventions that take place in that department of the hospital. As far as improvements go, I believe that as a health care team there is much more room for growth in the nonpharmacological area of pain management.
Especially for the pediatric population, fear of loss of control is huge when hospitalized. Both music and pet therapy interventions hand over a piece of control to the child’s hospitalization. Whether it is choosing the type of music or degree of interaction with the pet- children can confide in the comfort of control. Unfortunately, many aspects of the hospital stay cannot be controlled, but as nurses we have the power and opportunity to find the aspects where our patients can have a say in their care. It is also important to acknowledge the benefit that each of these five studies had for the parents. Although it was the child receiving the venipuncture, lumbar puncture, or immunization- parents are just as important in the child’s care. All studies showed that parents viewed the interventions as a positive, if not actually experiencing relief themselves (Young et al., 2010).
Conclusion
Based off of my analysis of these five studies, there are a few areas of future research that I would recommend. The music therapy research study with immunizations was completed with live music interventions (Sundar et al., 2016). I believe there is potential benefit in research that compares live music to music given through an electronic, such as the iPod experiment in the Emergency Department. The developmental age was not considered in any of these five studies, which in the pediatric setting, it a vital aspect to the care.
Although my knowledge is not expanded on different aspects of pet therapy, other than canines, I would be intrigued to see research completed with other pets. As a whole, there was one truth to all five studies that should be considered in the drive for future nonpharmacological pain management for pediatrics: that if pain is not addressed it “can lead to preprocedural anxiety in future, needle fear, and also health care avoidance behaviors” promoting the trust connection between patients and health care providers (Sundar et al., 2016, p. 745).
