The impact of listening to pleasant natural sounds on anxiety and physiologic parameters in patients undergoing coronary angiography: A pragmatic quasi-randomized-controlled trial

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Highlights

  • Reduction of anxiety and promotion of comfort in patients undergoing coronary angiography is an important challenge.

  • Listening to pleasant natural sounds as non-invasive and non-pharmacological therapy can reduce the level of anxiety reported by patients undergoing coronary angiography.

  • After listening to pleasant natural sounds, the intervention arm displayed significantly lower anxiety levels than the control arm during the intervention.

  • After listening to pleasant natural sounds, the physiological parameters of both groups showed statistically significant differences over time and in group-by time interactions.

  • Application of pleasant natural sounds for patients undergoing coronary angiography promotes nursing autonomy and the notion that nurses can influence the patient's environment.

Abstract

Objective

This study aimed to investigate the impact of listening to pleasant natural sounds on anxiety and physiological parameters in patients undergoing coronary angiography.

Methods

The present pragmatic quasi-randomized controlled clinical trial was conducted on 130 patients undergone elective angiography. The participants were randomly divided into two groups, including a pleasant natural sounds group, and a control group (n1/2 65 per group). Spielberger's state/trait anxiety inventory was used to assess levels of anxiety. The patients' anxiety level and physiological parameters were measured at baseline, before, during, immediately after, and 20 min after coronary angiography.

Results

The mean level of anxiety was similar in both arms at baseline (t = 1.317, df = 128, p = 0.190). The intervention arm displayed significantly lower anxiety levels than the control arm during the intervention (Wilks' lambda 0.11, Pillai's trace 0.89, P 0.001, F 2.05). The physiological parameters (systolic and diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation) of both groups showed statistically significant differences (p < 0.05) over time and in group-by time interactions.

Conclusion

As an effective nursing intervention presenting no side-effects, listening to pleasant natural sounds can be helpful in the management of anxiety.

Introduction

The prevalence of cardiovascular and circulatory diseases and associated mortality are increasing worldwide [1]. The highest ischemic heart disease (IHD) mortality rates are in Eastern Europe and Central Asia, and for working-age populations, IHD mortality rates are mostly higher in transitional and developing countries than in developed countries [2]. Coronary angiography is one of the most common invasive procedures to locate blocked coronary arteries, and plays an important role in determining treatment [3]. Although it is essential for the detection of cardiovascular disease, it can cause fear, anxiety, and emotional stress [4]. The coronary angiography laboratory with highly technical equipment and unfamiliar sounds can create a stressful situation for patients. More than 80% of patients scheduled for coronary angiography experience a decreased sense of control over bodily functions and a high level of anxiety before the procedure is commenced [5], [6]. Anxiety is highest whilst waiting for the procedure and immediately prior to the procedure, and lowest after the procedure [7]. An elevated level of anxiety may negatively influence patients' psychological and physiological wellbeing and may interfere with nursing care [8]. Patients may feel more anxious before coronary angiography than heart surgery [9].to prolongation or cancellation of the procedure, or impair cardiac functioning. Patients may interpret their symptoms as an impending heart attack [10]. Stress-related tachycardia and hypertension may cause clinical deterioration, dysrhythmia and an increase in the area of infarction [11].

Section snippets

Background

Angiography is an invasive diagnostic procedure that may be perceived as threatening or a threat to health [8], nurses should establish an environment that minimises stress [12]. Nurses in critical care settings such as the coronary angiography laboratory should balance the potential benefits of reduced anxiety with the possible adverse effects of sedatives, such as opioid and benzodiazepines, and explore alternative, less expensive and more efficient ways of alleviating patients' anxiety [13].

Study design

This pragmatic parallel group quasi-randomized controlled trial with a pre-intervention–post-intervention design was conducted with an intervention (n = 65) and a control arm (n = 65) from 1st April 2014 to 31st December 2014.

Participants and setting

This trial was undertaken with patients scheduled for elective coronary angiography in a high turnover, referral teaching hospital in Tehran. The angiography unit treats over 2000 patients every year. The study's inclusion criteria were: scheduled to undergo coronary

Ethical considerations

The institutional review board of Shahed University granted the ethical approval for the study (decree number: 41-198181). In Iran, public hospitals are run under the direct supervision of Universities. Therefore, the permission to enter the hospitals was granted by the ethics committees affiliated with Shahed University. Such permission to enter hospitals was approved by the hospital's directors and authorities. The research was registered in the Iranian Registry of Clinical Trials (IRCT)

Statistical analyses

SPSS for Windows version 21 was used for statistical analysis (IBM SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to summarize demographic and clinical characteristics of participants. Independent sample t-tests and Chi square tests were used to determine any significant differences in the variables distributions between the arms. The concurrent effect of time trend, intervention (group variable) and interaction between time and group on different response variables (state

Comparing trial arms

All 130 patients assessed were eligible for inclusion, and all were approached. All patients agreed to participate and fully collaborated throughout the study process. The CONSORT 2010 flow diagram is shown in Fig. 1. Independent t-tests and χ2 tests showed no significant differences between the two arms in terms of age, gender, marital status, level of education, employment status, health insurance status, and history of hospitalization (Table 1).

Pleasant natural sounds and anxiety

A statistically significant difference was

Discussion

Listening to pleasant natural sounds reduced the level of anxiety and tended to improve physiological parameters in patients undergoing coronary angiography. Focusing on pleasant sounds was an effective, non-pharmacological and unobtrusive comfort measure.

Anxiety is a common experience in hospitalised patients, particularly before invasive procedures such as coronary angiography [27].

Findings from the comparisons at the five time points indicated significantly lower levels of anxiety in the

Conclusions

Listening to pleasant natural sounds reduced the level of anxiety and physiological responses related to anxiety in patients undergoing coronary angiography. Pleasant natural sounds listening is a non-pharmacological intervention in high-tech critical care settings such as the coronary angiography laboratory where the noisy and stressful aspects of environments may stimulate nervous tensions. The pleasant natural sounds intervention provided a positive experience to patients. Given its

Conflicts of interest

None of the authors have any conflicts of interests with regards to this research.

Funding

This research was supported financially by a grant from the Shahed University, Tehran, Iran (grant number: 127/207147/9305).

Ethical approval

Shahed University Review Board, No. 41198181.

Study registry number

Iranian Registry of Clinical Trials (IRCT) approval: 201412047529N5.

Contributions

Study design: NR, MHK;

Data collection: NR, AJ;

Data analysis: SJ, SDT;

Manuscript preparation: NR, MV, SJ.

Final approval of the version to be submitted: NR, MHK, AJ, MV, SJ.

Acknowledgments

The researchers would like to thank the all of participants for their participation in this study.

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