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Published in CenterView on September 23, 2013
Kim Dukes Horn in the SICU
Kim Dukes Horn in the SICU

SICU pilot study examines music’s effectiveness in helping minimize hospital stays

By Gary Pettus

There’s a place at UMMC where patients may take in some Beyonce with their benzodiazepines; where Vince Gill may sing back-up for Versed; where Drake may perform a duet with Diprivan, featuring Jay Z.

The place is the Surgical ICU, where Kim Dukes Horn, nurse manager, has been leading a yearlong study of a familiar concept – the healing power of music – but with a couple of twists.

One of the twists: Patients undergoing this treatment aren’t awake.

Working with the Electronic ICU (EICU) – another twist – and the School of Nursing, Horn has recorded the responses of approximately 30 SICU patients so far in a pilot study, the first in her unit.

“Whenever we get another patient on board,” Horn said, “the nurses get a little excited. ‘What are we getting this time? The Eagles? Yes!’”

Although the study is “nurse-driven,” as Horn said, the music pumped into some of the 20 SICU rooms is, of course, for the patients’ benefit. And it’s not just any music, Horn said.

“We thought long and hard about this: What do we play for them? Do we let the patient’s family have a choice? Do we play nature sounds or classical music?

“Research has shown that classical music is relaxing, but we might have patients who don’t like Bach. I don’t want to make them mad.”

What she wants, and hopes her approach will accomplish, is to shorten patients’ hospital stays, consequently opening up beds for others. The way to do that is to shrink their time on the ventilator – the machine that helps them breathe – by decreasing their sedation medications: Versed (benzodiazepine) or Diprivan (hypnotic/amnestic).

The way to do that is to find a way to improve their heart rate, blood pressure, respiratory rate and so forth. The way to do that is to find a way to relax them, even in their sedation-induced sleep.

Even before the music-therapy study began, Horn encouraged families to bring in radios or recordings of the patient’s favorite music.

“The families who walk in here are completely overwhelmed,” she said. “They have no clue about what all these tubes and wires are for. It seems dehumanizing to them.

“If they can bring something that is personal, they can see that we’re not just paying attention to the wires and tubes; we’re paying attention to the patient as well.”

As for the patients, Horn said, “this is also a stressful place. They would tell you they’d rather be somewhere else. So we need to try and make it easier for them.”

And the way to do that, she theorizes, is to let them hear, even if it’s subconsciously, the soundtrack of their lives.

“The whole premise behind this truly began with my love of music,” said Horn, who played the piano while she was growing up in Mize.

While music therapy has been studied for years, she found little research that specifically targeted benzodiazepines, or benzos, a class of drugs used to treat anxiety, among other things. She also knew that music therapy has been used to reduce patient stays and ventilation times.

Many studies were done in extended-care facilities, such as nursing homes, where patients chose their music.

“Here, the patient has no idea we’re doing this,” Horn said. “The physician and the family have to consent.

“I know if I had to stay here in a bed for days, I would rest a lot better if I was listening to something I like.” 

Steve Harvey, a nurse in the SICU, is sold on this version of holistic care.

“When you ask families to bring a photo of the patient with them, when you ask them about his favorite music, you’re enabling them to bring his personality alive,” Harvey said. “So they don’t concentrate so much on what he looks and acts like as a patient lying in a bed. They can think of what he was like when he was well.

“And I like it, too. Who doesn’t like working while music’s playing?”

Whenever a patient is admitted, Harvey and the other nurses ask the family a series of questions to help them create a glade of comfort within a wilderness of menacing machines. Does he have a nickname? Does she like to sleep with her feet sticking out of the covers?

Does he prefer Tennessee Ernie Ford or Ke$ha?

The most unusual request so far? Temporary gospel. That’s what one woman asked for, but Horn knew what she meant.

“We’ve been able to fill every request,” she said. “And we haven’t had one refusal. I’ve heard family members say things like, ‘Oh, he will love that.’ And, ‘Thank goodness.’”

Dr. Sheila Keller also is singing the study’s praises. As senior director of research and evidence-based practice in the School of Nursing, she works with hospital nurses drawn to research and helps work up their projects.

As for Horn’s study, other researchers have been on the same track, more or less. For instance, research published online by the Journal of the American Medical Association in June studied ICU patients on ventilators, reporting that, compared with regular care, “patient-directed music intervention” produced lower levels of anxiety and sedation.

“But the majority of studies in music therapy have been on patients who were awake,” said Keller, an associate professor of nursing. “And researchers have used CDs or tapes with headphones. The problem with that is, you may be blasting the music too loud and we wouldn’t know it.”

Or maybe it’s not loud enough. Also, headphones can spread germs, a serious matter for patients whose immune systems are already compromised.

“We’re using the EICU here, which is probably what makes the study unique,” Keller said.

Designed primarily to serve as a second set of eyes trained on critical-care patients, the EICU in this case acts as a remote, personal disc jockey for up to two SICU patients at a time. Located in the UBS Building on I-55 North, the EICU can do this thanks to an online music streaming service, said Leslie Ishee, the unit’s nurse manager.

“It allows you to build your own radio station, without commercials,” Ishee said. “We loop the music through the EICU station. It’s piped into the SICU room through speakers for two hours at a time.”

In other words, no headphones were harmed in this study.

This is the first research project involving the EICU, Ishee said, “and it’s a wonderful use of our technology.”

It began simmering in Horn’s mind at least five years ago, back when her son, Jack, then 9, enlisted his family as guinea pigs in his science project. As he monitored their heart and respiration rates, he played two different types of music for an hour each, with a 30-minute interval between them.

First, he played classical music, and the vital signs showed that everyone was relaxed, Horn said.

“Then he played heavy metal, and everyone’s heart rate went up.”

The science fair judges were impressed, Horn said. “He won. I always had that in the back of my mind when I came here to the SICU.”

In her unit, patients remain an average of 0.78 days, she said, but some stay for weeks. The SICU has approximately 275 admissions per quarter, or about three per day. Decreasing the length of stay, even by hours, would benefit the hospital, where beds are sometimes at a premium, she said.

The results aren’t in yet – the study recently ended – but they will determine if a larger, follow-up study will be approved. So far, the documentation is encouraging to Horn, who hopes to see the findings published in one of the journals of the American Association of Critical-Care Nurses or the Mississippi Nurses’ Association.

“According to the data I’ve seen, music therapy does work,” she said.

Most of the patients in the music-less control group recorded no change. And even though all of the serenaded patients did not experience a change, many did, Horn said.

One of those was being treated for acute respiratory failure. Two hours after the sounds of gospel music flooded his room, his need for medication was cut in half, Horn said.

“Music seems to make the patients feel better, even if they don’t know it.”

As Horn was being interviewed for this article, she received another boost when a patient’s wife knocked on the door to announce that her husband’s heartbeat had slowed and his respiration had rallied.

A medical triumph for the Bill Gaither Vocal Band.