title: Effect of nature-based sounds' intervention on agitation, anxiety, and stress in patients under mechanical ventilator support: a randomised controlled trial.
abstract: BACKGROUND
  Few studies have been conducted to investigate the effect of nature-based sounds (N-BS) on agitation, anxiety level and physiological signs of stress in patients under mechanical ventilator support. Non-pharmacological nursing interventions such as N-BS can be less expensive and efficient ways to alleviate anxiety and adverse effects of sedative medications in patients under mechanical ventilator support.
  
  
  OBJECTIVE
  This study was conducted to identify the effect of the nature-based sounds' intervention on agitation, anxiety level and physiological stress responses in patients under mechanical ventilation support.
  
  
  METHODS
  A randomized placebo-controlled trial design was used to conduct this study. A total of 60 patients aged 18-65 years under mechanical ventilation support in an intensive care unit were randomly assigned to the control and experimental groups. The patients in the intervention group received 90 min of N-BS. Pleasant nature sounds were played to the patients using media players and headphones. Patients' physiological signs were taken immediately before the intervention and at the 30th, 60th, 90th minutes and 30 min after the procedure had finished. The physiological signs of stress assessed were heart rate, respiratory rate, and blood pressure. Data were collected over eight months from Oct 2011 to June 2012. Anxiety levels and agitation were assessed using the Faces Anxiety Scale and Richmond Agitation Sedation Scale, respectively.
  
  
  RESULTS
  The experimental group had significantly lower systolic blood pressure, diastolic blood pressure, anxiety and agitation levels than the control group. These reductions increased progressively in the 30th, 60th, 90th minutes, and 30 min after the procedure had finished indicating a cumulative dose effect.
  
  
  CONCLUSIONS
  N-BS can provide an effective method of decreasing potentially harmful physiological responses arising from anxiety in mechanically ventilated patients. Nurses can incorporate N-BS intervention as a non-pharmacologic intervention into the daily care of patients under mechanical ventilation support in order to reduce their stress and anxiety.
authors.affiliation: Department of Nursing, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Saadatmand
authors.forename: Nahid
authors.initials: N
authors.lastname: Rejeh
authors.forename: Majideh
authors.initials: M
authors.lastname: Heravi-Karimooi
authors.forename: Sayed Davood
authors.initials: SD
authors.lastname: Tadrisi
authors.forename: Farid
authors.initials: F
authors.lastname: Zayeri
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Vaismoradi
authors.forename: Melanie
authors.initials: M
authors.lastname: Jasper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019368:Nature; D009622:Noise; D010919:Placebos; D011595:Psychomotor Agitation / Q000628:therapy*; D012121:Respiration, Artificial; D013315:Stress, Psychological / Q000628:therapy*; D055815:Young Adult
chemical_list: D010919:Placebos