Research Methodology: Research Design: Two group pretest posttest design. Population: Patients who are hypertensive and are anxious during the procedure of hemodialysis.
Sampling technique: Simple random sampling (lottery method).
Sample size: 60 samples (30 in experimental and 30 in control group).
Setting: Choithram Hospital and Research Center, Indore.
Tool: The tool consisted of three sections.
Socio Demographic Variables:
This section consists of seven items for obtaining information about selected demographic variables such as age, gender, religion, educational status, occupation, economic status and marital status.
This section consists of five items for obtaining information about clinical variables such as type of illness, duration of hemodialysis, history of any co-morbid illness, history of taking medication for hypertension and previous experience of music therapy to reduce anxiety during
Blood pressure assessment:
In this section assessment of blood pressure is done by the investigator using mercurial sphygmomanometer and charted as Systolic and Diastolic blood pressure in millimeters of mercury (mm Hg).
The scoring is done in following manner:
i. Hypotension (Systolic BP- ≤ 110 / diastolic BP- ≤ 70).
ii. Normal (Systolic BP-120−130/ diastolic BP — 80−90).
iv. Mild hypertension (Systolic BP- 140−159/ Diastolic Bp 90−99).
v. Moderate hypertension (Systolic BP- 160−179/ Diastolic BP- 100- 109).
vi. Severe hypertension (Systolic BP- ≥ 180 / Diastolic BP- ≥ 110).
Standardized Beck Anxiety Inventory-I for anxiety assessment:
This section consists of the standardized tool given by Dr. Araon. T. Beck. It contains a list of common symptoms of anxiety, there are total 21 items. Scoring has been categorized in following manner: Not at all- 0, Mild anxiety-1, Moderate anxiety-2, and Severe anxiety- 3, 0−21- low anxiety, 22−35- moderate anxiety, >36 — severe anxiety.
The tool was submitted to 9 experts including 5 nursing personnel from the field of Medical Surgical Nursing, two musicians, one Nephrologist and one Statistician. The experts were requested to check for the relevance, sequence and language of the Section A, and express their opinion regarding the Section B, Section C and D of the tool.
The tool used was Standardized Beck Anxiety Inventory-I which has a well established reliability of r =0 .94 — 0.96 in illiterate and literate people.
The reliability for blood pressure assessment tool was done by using test re-test method and was found the r=1.0 for BP instrument i. e mercurial sphygmomanometer which was used for assessing blood pressure.
Procedure for Data Collection:
The administrative authority and research ethics committee of Choithram Hospital and Research Centre, Indore had given permission prior to the data collection. The study was carried out in the same way as that of the pilot study. A total of 60 samples were selected from the accessible population as study subjects through simple random sampling (lottery method) and then the subjects were assigned to experimental (30) l and control group (30) by randomization.
The actual data collection period was from 1st April 2014 to 1stMay 2014. The procedure for data collection was divided into preprocedure, procedure and post procedure.
Selected the samples as per the inclusion criteria of the study. Through simple random sampling (lottery method) 60 samples were further assigned to experimental and control groups. Procedure was explained and consent was taken from all samples.
Before intervention pretest blood pressure and anxiety score was obtained on the 1st and 2nd hemodialysis days to mark the baseline values of blood pressure and level of anxiety on hemodialysis and average of the 1st and 2nd d day were taken as pretest score. After determining the values of blood pressure and level of anxiety with the formulated tool, music therapy was administered to the experimental group of patients in following manner; 1st cycle (20 min music) on starting of dialysis, 2nd cycle (20 min) with a gap of 1 hour during the procedure and 3rd cycle (20 min) before half an hour of closure of procedure) was given. The researcher herself conducted the music therapy sessions with the help of (MP3) player and headphones It was a two day session for each patient. Each sessions consisted of three cycles of music i.e. four different patterns of Kalavati Raag played for the duration of 20 minutes. Before that the patient was instructed to relax completely and to concentrate on the music played. The environmental factors which distract the patients were minimized for each cycle of music. Trial out of the listed music was also kept and the patients were asked to select as per their choice in order to assess which type of music is most preferred by each patient. Subjects in the control group were asked to continue with routine care. The intervention was done on 4th and 5th hemodialysis days after the samples were selected for the study.
Posttest was taken on the 4th and 5th hemodialysis days after the samples were selected for the study, soon after the intervention to assess the post intervention changes in blood pressure and anxiety level on hemodialysis and an average of 4th and 5th and day were taken as post-test score.
Findings: Socio Demographic Characteristics:
Among all the study participants, more than one-third of the samples i.e.11 (36.67%) in the experimental group and 9(30%) in the control group belonged to the age group of 36−45 years of age. In the experimental group male samples 21 (70%) outnumbered the female samples 9 (30%) and in the control group also male samples 20(66.67%) outnumbered the female samples 10(33.33%).
Regarding religion, majority 24 (80%) the experimental group and 19 (63.33%) in the control group were Hindus.
In relation to the educational status, nearly half of the samples in the experimental group i.e.13 (43.34%) had high school education and in the control group more than one third of the samples 11 (36.67%) were having middle school education.
It was found that more than one-third i.e. 11(36.67%) of the study participants in the experimental group and 9(30%) of the study participants in the control group were unemployed.
The data concerning economic status revealed that one third of the samples 10(33.33%) in the experimental group were having monthly income of Rs.10,000- 20,000 and nearly half of the samples i.e.13 (43.33%) in the control group were having a monthly income of < Rs 20,001−30,001/-. Regarding the marital status nearly three fourth i.e.20 (66.67%) of the study samples in the experimental group and 21 (70%) in the control group were married.
Majority of the samples i. e 25 (83.33%) in the experimental group were undergoing hemodialysis for more than six months and more than three fourth of the samples
22(73.33%) in control group were undergoing hemodialysis for more than six months.
Nearly three fourth of the samples 22(73.33%) both in the experimental and control group were having the history of anemia as co-morbid illness.
It was found that all the study participant in both the experimental group and control group 30(100%) were having history of taking medication for hypertension before hemodialysis.
Both the experimental group and control group i. e 30(100%) were not having any previous experience of music therapy to reduce anxiety during hemodialysis.
Assessment of values of blood pressure during hemodialysis among experimental group:
Data in figure-1 shows that values of blood pressure during hemodialysis among experimental group on blood pressure assessment tool. It depicts that more than three fourth of the samples i.e. 24 (80%) were having severe hypertension and less than one fourth 6 (20%) were having moderate hypertension before intervention.
After the music therapy, there was reduction in the values of blood pressure as more than three-fourth of the samples i.e. 26 (86.67%) were having normal blood pressure and less than one fourth 4 (13.33%) were having mild hypertension.
Frequency and Percentage of values of blood pressure during hemodialysis among control group:
Data presented in figure-2 shows that values of blood pressure during hemodialysis among control group on blood pressure assessment tool. It depicts that more than three fourth of the samples i.e.23 (76.67%) were having severe hypertension and less than one fourth 7 (23.33%) were having moderate hypertension before intervention. In post test, no change was found.
Assessment of level of anxiety during hemodialysis among experimental group:
Data presented in figure-3 shows the level of anxiety during hemodialysis among experimental group measured on Beck Anxiety Inventory.-I. It depicts that more three fourth of the samples i.e. 24 (80%) were having moderate anxiety and less than one-fourth (20%) were having severe anxiety in pretest. After music therapy there was reduction in the level of anxiety i. e 30(100%) of the samples were having mild anxiety.