Nursing and Health Sciences (2011), 13, 412418

Research Article

Music as a nursing intervention: Effects of music listening

on blood pressure, heart rate, and respiratory rate in
abdominal surgery patients
nhs_633

412..418

Anne Vaajoki, MNSc, rn, Pivi Kankkunen, phd, rn, Anna-Maija Pietil, phd, rn and
Katri Vehvilinen-Julkunen, phd, rn
Department of Nursing Science, University of Eastern Finland, Kuopio, Finland

Abstract

Contradictory results have been presented on how music listening affects patients blood pressure, heart rate,
and respiratory rate. The aim of the present study was to evaluate the effects of music listening on blood
pressure, heart rate, and respiratory rate on operation day, and on the first, second, and third postoperative
days in abdominal surgery patients. Using a quasi-experimental pretestpost-test design, 168 abdominal
surgery patients were assigned every second week to the music group (n = 83) or to the control group (n = 85)
for 25 months. In the music group, the respiratory rate was significantly lower after intervention on both the
first and second postoperative days compared with the control group. A significant reduction in systolic blood
pressure was demonstrated in the group that received music compared with the control group on both the first
and second postoperative days. Evaluation of the long-term effects of music on physiological factors showed
that the respiratory rate in the music group was significantly lower compared with the control group. Nurses
should offer music listening to surgery patients because of its potential benefit.

Key words

abdominal surgery, non-pharmacological method, music intervention, postoperative pain, quasi-experimental

design.

INTRODUCTION
Postoperative pain and surgery are both physiological and
psychological stressors that activate the sympathetic nervous
system by increasing heart rate, blood pressure, and peripheral vascular resistance. Surgery, especially in the abdominal
region of the body, can produce postoperative moderate to
severe pain and result in respiratory dysfunction, because an
upper abdominal surgery wound is in the breathing area and
interferes with abdominal muscle use for deep breathing,
coughing, and moving (Ashburn et al., 2004).
The theoretical background for music intervention can be
explained by gate control theory. The gate can be closed from
inside using cognitivebehavioral methods, such as music
listening, so that stimulus of pleasant music distracts thoughts
from pain, relaxes muscles, evokes an affective response, and
via a descending inhibitory system, closes the gate. Postoperative pain can be assessed on the basis of the patients
behavior and by rating their intensity of pain or recognizing
pain from physiological factors, such as blood pressure, heart
rate, respiratory rate, peripheral thermal stimuli, and complexion (Melzack & Katz, 2006).
Correspondence address: Anne Vaajoki, PO Box 1627, 70211 Kuopio, Finland. Email:
anne.vaajoki@uef.fi
Received 2011 May 03; accepted 2011 July 03.

2011 Blackwell Publishing Asia Pty Ltd.

Music listening is a non-pharmacological method that can

focus attention (Kwekkeboom, 2003), facilitate breathing,
and stimulate the relaxation response (McCaffrey & Locsin,
2002). Music elicits unique experiences in the listener at different times, and depends on an individuals physiology, mind
state, and mood. It is essential to identify the types of music
that the listener prefers (Leardi et al., 2007).
Music listening used in nursing practice should be distinguished from music therapy, because most nurses have no
music therapy education nor are they usually present while
patients listen to music. Moreover, a nurse does not evaluate
a patients psychological and physiological entity in relation
to rhythm, melody, and harmony (Masuda et al., 2005;
Nilsson, 2009). The present study concentrates on the effects
of music listening on blood pressure, heart rate, and respiratory rate in pain management. An earlier article (Vaajoki
et al., in press) discusses music and its effects on pain intensity
and pain distress.

METHODS
Literature review
This literature review focuses on the effect of music listening
studies on patients postoperative blood pressure, heart rate,
and respiratory rate. In the last 6 years, there have been no
doi: 10.1111/j.1442-2018.2011.00633.x

Music as a nursing intervention

studies that have evaluated the effects of music on respiratory rate after surgery. The research results of listening to
music and its effects on blood pressure and heart rate after
surgery are contradictory. Interventions were conducted
during (Nilsson et al., 2005) and/or after surgery (Masuda
et al., 2005; Tse et al., 2005; Sendelbach et al., 2006; Nilsson,
2009).
Six studies did not show significant differences between
the music group and the control group in blood pressure or
heart rate (Masuda et al., 2005; Nilsson et al., 2005; Sendelbach et al., 2006; Nilsson, 2009; Allred et al., 2010). Nilsson
et al. (2005) did not obtain any differences in vital signs
between the groups of open hernia repair patients. Masuda
et al.s (2005) sample consisted of orthopedic patients, and the
intervention was done on the third postoperative day. There
were no differences in blood pressure and heart rate between
the music and control groups.
In cardiac surgery patients, the effects of listening to music
on blood pressure and heart rate have been investigated by
Sendelbach et al. (2006) and Nilsson (2009). Cardiac surgery
patients listened to music between the first and third postoperative days. Neither study found differences in blood
pressure or heart rate between the two groups.
Tse et al. (2005) obtained contradictory results with
patients who listened to music after nasal surgery. Music
group patients had lower systolic blood pressure and heart
rates than patients in the control group. Participants
listened to music both on the operation day and on the first
postoperative day.
In summary, previous studies on patients music listening
after surgery have used different methodological approaches
that impact reliability and the appropriateness of generalizing findings. Music interventions used in these studies
were different types of surgeries at different times during the
perioperative period.

Study
Aim
The aim of this study was to evaluate the effects of music
listening on blood pressure, heart rate, and respiratory rate
in postoperative abdominal surgery patients. The following
hypothesis was tested: Patients in the music group will have
significantly lower systolic and diastolic blood pressure, heart
rate, and respiratory rate than those in the control group.

Study design
A quasi-experimental pretestpost-test design was used,
with one music group and one control group. A repeatedmeasures design was used, in which each patients systolic
and diastolic blood pressure, heart rate, and respiratory rate
were measured before and after intervention between the
operation day and the second postoperative day. Physiological parameters were measured only once every time to avoid
stressing the patient too much, and thus affecting those
parameters. Music was played in the evening of the operation
day and on the first and second postoperative days in the

413

morning (8.009.00 hours), at midday (13.0015.00 hours),

and in the evening (18.0020.00 hours). On the third postoperative day, blood pressure, heart rate, and respiratory rate
were measured once.

Sample and setting

A calculation of the required sample size was based on the
power analysis with respect to Visual Analogue Scale pain,
because this is an intervention study concerning postoperative pain management. A mean of 3.5 and standard
deviation (SD) of 2.4 were expected. A clinically-significant
difference of 30% and statistically-significant level of 0.05
were expected. With a power of 80%, a sample size of 83
patients for each group (n = 166) was calculated as being
appropriate (Burns & Grove, 2005). A pilot study was conducted with 10 patients. After the pilot study, changes were
made to the pain assessment so that patients assessed both
pain intensity and pain distress while resting, during deep
breathing, and when shifting position.
The patients in the study sample (n = 280) were adults
(2185 years) undergoing elective abdominal surgery in
Kuopio University Hospital (Kuopio, Finland) over a period
of 25 months. Patients eligible for the study had epidural
analgesia after surgery; their estimated hospital stay was at
least 4 days, and the anesthesia physical status classification
(ASA) was 13. Patients suffering from drug abuse, psychiatric disorders, hearing impairment, dementia, or chronic
pain problems, or patients admitted to other departments,
were excluded.
In the main study, 22 patients refused to participate. Fifteen
patients withdrew after surgery because they were very tired
or the surgeon had given them bad news after the operation.
Nineteen patients were excluded for research reasons; for
example, patients did not get epidural analgesia, despite the
anesthesia plan, or surgery was delayed or cancelled. Fortysix patients did not meet the inclusion criteria. The final
sample comprised 168 participants, with 83 in the music
group and 85 in the control group.

Measurements
Blood pressure and heart rate were measured with an automatic OMRON M5-I or OMRON M6 (Dalian, China) by
one researcher (AV). The same machines, which were calibrated once a year by an equipment maintenance engineer,
were used throughout the research. The respiratory rate
is the number of respirations per minute and was obtained
by counting the number of times the patients chest rose and
fell for 1 min. After the final measurements on day 3, the
researcher conducted a structured interview if patients had
not completed a questionnaire by themselves. Participants
were asked about music-exposure frequency, musical background, and their favorite music. Moreover, there was an
open question: What else would you like to say?

Music as an experimental intervention

The patients chose their favorite music out of 2000 songs. The
alternatives were domestic or foreign hit songs, dance, pop,
2011 Blackwell Publishing Asia Pty Ltd.

414

rock, soul and blues, spiritual, or classical music. The participants were given their favorite music. This procedure was
based on data from an earlier study (Leardi et al., 2007) and
discussions with the music therapist. There were two headphones (HD 555; Sennheiser, Tullamore, Ireland and K28NC;
AKG, Vienna, Austria) and two MP3 players (Apple
iPod 8GB; Apple, Cupertino, CA, USA), on which different
kinds of music were recorded. Selections of music were
added according to participants wishes during the study. The
researcher talked with the participants about music they
liked, and showed a music list prior to the day of surgery.
The intervention started in the evening of the operation
day, if patients were discharged from the post-anesthesia care
unit. Before intervention, the researcher measured patients
systolic and diastolic blood pressure, heart rate, and respiratory rate. After the measurements were taken, patients in the
music group listened to their choice of music via headphones
for approximately 30 min. After the intervention, the same
measurements were repeated. In the control group, systolic
blood pressure, heart rate, and respiratory rate were measured at half-hour intervals, but the patients did not listen to
music. The intervention was repeated seven times during the
operation day and second postoperative days. All participants were provided epidural analgesia, which was adjusted
according to patients pain scoring and intravenous paracetamol 1 g three/day after surgery. When needed, parental oxycodone was provided as rescue analgesia.

Ethical considerations
The Research Ethics Committee Hospital of the District
of Northern Savo approved the study. All participants were
given a written, informed consent form, and they had opportunity to ask about it. Participation was voluntary, and refusal
to participate did not affect the care received during hospitalization. It was also possible to stop participation without
any specific reason.

A. Vaajoki et al.

The intervention was repeated seven times. The researcher

met the participants a total of nine times: prior to the day of
surgery, in the evening of the operation day (if the patient
arrived on the ward), on the first and second postoperative
days in the morning (8.009.00 hours), at midday (13.00
15.00 hours), in the evening (18.0020.00 hours), and once on
the third postoperative day. Intervention was carried out in
the patients room alongside normal care.

Data analysis
The computer program SPSS 16.0 for Windows (SPSS,
Chicago, IL, USA) was used for all statistical analyses. Complete data were obtained for 168 of the 280 abdominal
surgery patients. The data were presented as frequencies,
percentages, mean values, and SD. Descriptive statistics
were computed, and c2-tests were used to test independence
of treatment group assignment. The parametric test used
was ANOVA for repeated measurement in order to analyze
the systolic and diastolic blood pressure, heart rate, and respiratory rate over time between the groups. On the first and
second postoperative days, systolic and diastolic blood pressure, heart rate, and respiratory rate measurements were
presented as means and SD. Because of missing data totaling over 50%, the operation day was dropped from the
analysis. The main reason for this was that most of the
operations were major abdominal cancer surgeries. Patients
were discharged from the post-anesthesia care unit late in
the evening or even the next day. They were also extremely
tired because of the operation, anesthesia, and analgesia.
One patient in the control group suffered from delirium on
the third postoperative day and could not complete the
questionnaire, and the researcher could not measure physiological parameters on that day. The long-term effect of
music on systolic and diastolic blood pressure, heart rate,
and respiratory rate was analyzed by the non-parametric
MannWhitney U-test for independent groups (Burns &
Grove, 2005).

Procedure
Before the pilot study, it was determined that elective
abdominal surgery patients would be assigned to the music
group or the control group via an alternate-week arrangement according to a yearly calendar. For example, patients
admitted to hospital in one week were assigned to the experimental group, and patients admitted in the next week were
assigned to the control group. This process was repeated until
each group had 83 patients.
Participants were screened from departments operation plan lists every week, and the researcher counted
patients who potentially met the inclusion criteria. Prior to
the day of surgery, the researcher familiarized herself with
the patients paper and estimated exclusion and inclusion
criteria, and checked the final operation and anesthesia
plan. The researcher interviewed and informed patients prior
to the day of surgery. All the patients were told about the
purpose of the study and they were told whether they
were assigned to the music or the control group before any
decision to participate was required.
2011 Blackwell Publishing Asia Pty Ltd.

RESULTS
Demographic data
In the music group, the mean age was 60 years (range:
4773 years), and in the control group, the mean age was
63 years (range: 5175 years). Most of the participants were
married/common-law marriage (74%), retired (61%), and
had completed vocational school or had no education
(67%).
Participants had a variety of diagnoses for laparotomy:
ventral hernia (n = 6, 4%), diverticulitis (n = 13, 8%), and
colitis ulcerous/Morbus Crohn (n = 21, 13%). The majority
underwent surgery for a diagnosis of cancer (n = 110, 65%).
The sample for this study consisted of 168 individuals in
two groups undergoing elective abdominal surgery. The
groups did not differ in terms of age, sex, education, occupation, marital status, diagnosis, type of surgery, ASA, or doses
of analgesia. (Table 1). Participants musical background,

Music as a nursing intervention

Table 1.

415

Background data of the abdominal surgery patients in the music and control groups

Background variables
Age (mean, SD)
Sex (male/female)
Education
No education
Vocational school
College
Polytechnic/university or other
Employment status
Higher/lower office worker
Employee/entrepreneur
Student/other
Retired
Marital status
Married/common-law marriage
Single
Widow
Divorced/separated
Diagnosis for laparotomy
Ventral hernia
Diverticulitis
Carsinoma intestinal
Carsinoma ventriculi
Carsinoma pancreas
Colitis ulcerosa/Morbus Crohn
Other
ASA
1
2
3

Music group (n = 83), n, %

Control group (n = 85), n, %

60 (13)
42/41

63 (12)
48/37

20 (24)
35 (43)
14 (17)
13 (16)

20 (24)
37 (43)
15 (18)
13 (15)

12 (14)
22 (27)
2 (2)
47 (57)

9 (11)
18 (21)
3 (3)
55 (65)

60 (72)
8 (10)
8 (10)
7 (8)

65 (77)
7 (8)
5 (6)
8 (9)

3 (4)
5 (6)
39 (47)
7 (8)
10 (12)
15 (18)
4 (5)

3 (4)
8 (10)
35 (41)
7 (8)
12 (14)
6 (7)
14 (17)

5 (6)
33 (40)
45 (54)

2 (2)
34 (41)
48 (57)

c2-test

d.f.

P-value

0.58
0.04

1
5

0.149
0.466
0.998

0.85

0.652

1.00

0.801

10.48

0.106

1.39

0.499

*P < 0.05. n = 82, missing data of education. n = 84, missing data of anesthesia physical status classification (ASA). SD, standard deviation.

music exposure frequency, and favorite music did not differ

between the two groups. Nearly half (46%) of the participants said they had no interest in music. The majority of
participants in both groups were exposed to music at a frequency of once a day or more often. Of those who listened to
music, nearly half (47%) liked domestic hit/dance music
(Table 2).
The means and SD of respiratory rate, systolic and diastolic blood pressure, and heart rate scores on the first and
second postoperative days for the two groups at each of the
pretests and post-tests are shown in Tables 3 and 4. The
long-term effects of music on systolic and diastolic blood
pressure, heart rate, and respiratory rate were evaluated on
day 3. For systolic and diastolic blood pressure or heart rate,
no statistically-significant differences were found. In the
music group, the respiratory rate (15/min-1) was significantly
lower (P = 0.001) than in the control group (18/min-1).
(Table 5).
In the music group, 47 of 83 (57%) patients answered the
open question. Participating in the study and music listening
were a positive experience for 18 of 47 (38%) patients. Out of
a total of 47, 21 patients (45%) mentioned that they were
satisfied with the postoperative care. In the control group, 44
of 84 (52%) patients answered the open question, and par-

ticipating in the study was a positive experience for 13 of 44

(30%). Out of a total of 44 patients, 23 (52%) mentioned that
they were satisfied with the postoperative care.

Hypothesis testing
The hypothesis that music listening results in significantly
lower systolic and diastolic blood pressure, respiratory rate,
and heart rate than in the control group was partly supported. ANOVA for repeated measurements indicated that
on days 1 and 2, the postoperative patients in the music group
had lower respiratory rates and systolic blood pressure levels
compared with the control group.
On the first postoperative day, the post-test mean for respiratory rate in the music group (16/min-1) was significantly
lower (P = 0.001) than in the control group (18/min-1). The
post-test mean for systolic blood pressure on day 1 in the
music group was significantly lower (P = 0.05) compared with
the control group (Table 3).
On the second postoperative day, the pretest mean for
respiratory rate in the music group (17/min-1) was significantly lower (P < 0.001) than in the control group (18/min-1).
In addition, the post-test mean for respiratory rate in the
music group (16/min-1) was significantly lower (P < 0.001)
2011 Blackwell Publishing Asia Pty Ltd.

416

Table 2.

A. Vaajoki et al.

Patients music preferences in music group and control group

Music group (n = 83)
n
%

Music preferences
What is your music interest?
Only listen to music
Listen, play, sing
No interest
Music exposure frequency
Once a day or more often
Once a week, rarely or never
What is your favorite music
Hit/dance music
Domestic/foreign pop, rock
Classical/religious music
All kinds of music/not mentioned above

Control group (n = 84)

n
%

25
20
38

30
24
46

26
19
39

31
23
46

73
10

88
12

70
14

83
17

39
10
14
20

47
12
17
24

32
11
14
26

39
13
17
31

c2-test

P-value

0.052

0.97

0.724

0.39

1.520

0.68

One missing data item.

Table 3.

Patients physiological parameters on the first postoperative day before and after music intervention between the two groups

First postoperative day

Prevalue
Respiratory rate
Heart rate
Systolic Bp
Diastolic Bp
Post value
Respiratory rate
Heart rate
Systolic Bp
Diastolic Bp

Music group (n = 83)

Mean (SD)

Control group (n = 85)

Mean (SD)

P-value

17/min (3)
78/min (12)
126 mmHg (16 mmHg)
69 mmHg (9 mmHg)

18/min (3)
75/min (14)
128 mmHg (18 mmHg)
69 mmHg (11 mmHg)

0.33
0.23
0.52
0.89

16/min (2)
77/min (13)
124 mmHg (15 mmHg)
68 mmHg (9 mmHg)

18/min (3)
78/min (15)
126 mmHg (18 mmHg)
68 mmHg (11 mmHg)

0.001*
0.62
0.05*
0.13

*P 0.05. Repeated-measures ANOVA. Bp, Blood pressure; SD, standard deviation.

Table 4.

Physiological parameters on the second postoperative day before and after intervention between the two groups

Second postoperative day

Prevalue
Respiratory rate
Heart rate
Systolic Bp
Diastolic Bp
Post value
Respiratory rate
Heart rate
Systolic Bp
Diastolic Bp

Music group (n = 83)

Mean (SD)

Control group (n = 85)

Mean (SD)

P-value

17/min (2)
77/min (13)
134 mmHg (17 mmHg)
75 mmHg (9 mmHg)

18/min (3)
78/min (15)
140 mmHg (21 mmHg)
78 mmHg (11 mmHg)

0.001*
0.34
0.32
0.95

16/min (3)
77/min (13)
132 mmHg (17 mmHg)
75 mmHg (8 mmHg)

18/min (3)
77/min (14)
138 mmHg (20 mmHg)
77 mmHg (10 mmHg)

0.001*
0.79
0.04*
0.14

*P 0.05. Repeated-measures ANOVA. Bp, Blood pressure; SD, standard deviation.

than in the control group (18/min-1). The post-test mean for

systolic blood pressure on day 2 in the music group was
significantly lower (P = 0.04) compared with the control
group (Table 4).
2011 Blackwell Publishing Asia Pty Ltd.

There were no statistically-significant differences in diastolic blood pressure or heart rate on the first (Table 3)
or second postoperative day (Table 4) between the two
groups.

Music as a nursing intervention

Table 5.

417

Systolic and diastolic blood pressure, heart rate, and respiratory rate on the third postoperative day

Third postoperative day

Systolic Bp
Diastolic Bp
Heart rate
Respiratory rate

Music group (n = 83)

Mean (SD)

Control group (n = 85)

Mean (SD)

MannWhitney U-test

P-value

140 mmHg (23 mmHg)

81 mmHg (10 mmHg)
75/min (16/min)
15/min ( 4/min)

147 mmHg (24 mmHg)

82 mmHg (11 mmHg)
74/min (14/min)
8/min ( 3/min)

2814.0
3120.5
3391.5
1760.0

0.31
0.24
0.76
0.001*

*P 0.05. Repeated-measures ANOVA. Bp, Blood pressure; SD, standard deviation.

DISCUSSION
Study limitations
There are certain methodological issues related to this study
that need to be addressed. First, only one researcher (AV)
collected the data. This has advantages and disadvantages.
The researcher has extensive experience in working on a
surgical ward. Physiological measures were always taken in
the same way and in the same order. Blood pressure and
heart rate were measured with an automatic OMRON M5-I
or OMRON M6 by one researcher (AV). These machines
were also used on the ward. The presence of the researcher
throughout the procedure might have influenced the participants to have a more positive response. In both groups, those
who answered the open question said that participating in
the study was a positive experience. The researcher was not
blinded to the group assignment. Second, the sample size was
based on a power analysis, and the data were collected over a
25-month period. Third, all data were collected in only one
hospital, so the results cannot be generalized.

Main findings
The aim of the study was to evaluate the effects of music
listening on blood pressure, heart rate, and respiratory rate
in postoperative abdominal surgery patients as part of an
intervention study of pain management. The findings indicated that music listening resulted in a significantly lower
respiratory rate and systolic blood pressure on both the first
and second postoperative days. There were no differences
between the two groups in diastolic blood pressure or heart
rate. This result is different from that of previous studies by
Nilsson (2009), Sendelbach et al. (2006) and Masuda et al.
(2005), in which there were no differences in blood pressure
or heart rate. The results of this study are partially consistent
with those of Tse et al. (2005), in which both blood pressure
and heart rate levels were lower in the music group than in
the control group. Although the results of these studies are
not completely comparable, it has been reported that both
cardiac and upper abdominal surgeries are painful and have
an effect on breathing. Lower respiratory rate levels in the
music group might be as a result of well-managed analgesia,
but also because of the possibility of patients listening to the
music they preferred (Mitchell et al., 2006). Favorite and
familiar music possibly makes patients relaxed (Nilsson,

2009), so muscle tension is reduced and their respiration

becomes deeper and steadier. Usually, people like music that
evokes positive, or reduces negative, emotions. In this study,
patients were pleased because they were allowed to select
their preferred music. Another explanation might be that
after surgery, patients felt relief and gratitude, because the
operation was over, regardless of a cancer diagnosis (Worster
& Holmes, 2009).
In this study, systolic blood pressure and respiratory rate
levels in the music group were lower before intervention.
The reason remains somewhat unclear, because there were
no significant differences in socioeconomic status, age, sex,
ASA classification, diagnosis, or analgesia between the two
groups, nor were there any significant differences in musical
preferences.
On the third postoperative day, the music group patients
respiratory rate levels were significantly lower compared
with the control group, even though they were no longer
listening to music. Good et al. (2002), who studied the effects
of music, relaxation, and the combination of relaxation and
music in postoperative settings, obtained the same result, but
after intervention. Physiological indicators, such as changes
in blood pressure, heart rate, and respiratory rate, might be
associated with pain and with the drugs used to treat it, but
pain is also affected by disease and other sources of distress
(Herr et al., 2006; Arbour & Glinas, 2010). In this study,
music intervention was organized in patients rooms during
normal care. Patients were occasionally disrupted during the
intervention because of a doctors round, nursing action, telephone calls, or visits by close relatives. These interruptions
sometimes disturbed and irritated patients, and they might
have had an influence on physiological parameters. Although
systolic blood pressure and respiratory rate levels were
significantly lower in the music group, variations in all
physiological factors were normal in both groups.

Conclusions
This study has provided statistical support for the notion that
music listening is associated with significantly lower systolic
blood pressure and respiratory rate on the first and second
postoperative days. Moreover, music might have a long-term
effect on respiratory rate. Additionally, the study found that
music listening is a positive experience.
To verify these results, we need to conduct further studies.
There is a need to study the effect of music on respiratory
2011 Blackwell Publishing Asia Pty Ltd.

418

rate after surgery. It is also important to evaluate the effects

of music in other surgery patient groups in several hospitals
at the same time. Further studies are also needed to examine
the effect of music and other non-pharmacological interventions on postoperative pain, such as relaxation, imagery, and
distraction (by arranging some meaningful activities, such as
watching television/films or reading) using qualitative
methods. Further studies are also needed of the nurses views
of using the non-pharmacological methods.
Nurses should be encouraged to strengthen their
knowledge of the benefits of music listening as a nonpharmacological intervention. This would ensure that music
becomes part of the healing environment to support surgical
patients during their recovery period.
This study indicates that music listening might be an
acceptable, low-risk intervention in clinical practice, and it
also indicates that music has positive effects on patients
experiences while they are in hospital.

ACKNOWLEDGMENTS
The authors wish to thank Mr Vesa Kiviniemi, statistician,
University of Eastern Finland, for sharing his expertise in
the statistical analysis. The study was financially supported
by Kuopio University Hospital EVO funding, the Finnish
Association of Caring Sciences, and the Foundation of Nurse
Education.

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