title: Effect of nature-based sound therapy on agitation and anxiety in coronary artery bypass graft patients during the weaning of mechanical ventilation: A randomised clinical trial.
abstract: BACKGROUND
  Weaning from mechanical ventilation is a frequent nursing activity in critical care. Nature-based sound as a non-pharmacological and nursing intervention effective in other contexts may be an efficient approach to alleviating anxiety, agitation and adverse effects of sedative medication in patients undergoing weaning from mechanical ventilation.
  
  
  OBJECTIVE
  This study identified the effect of nature-based sound therapy on agitation and anxiety on coronary artery bypass graft patients during weaning from mechanical ventilation.
  
  
  METHODS
  A randomised clinical trial design was used. 120 coronary artery bypass graft patients aged 45-65 years undergoing weaning from mechanical ventilation were randomly assigned to intervention and control groups. Patients in the intervention group listened to nature-based sounds through headphones; the control group had headphones with no sound. Haemodynamic variables, anxiety levels and agitation were assessed using the Faces Anxiety Scale and Richmond Agitation Sedation Scale, respectively. Patients in both groups had vital signs recorded after the first trigger, at 20 min intervals throughout the procedure, immediately after the procedure, 20 min after extubation, and 30 min after extubation. Data were collected over 5 months from December 2012 to April 2013.
  
  
  RESULTS
  The intervention group had significantly lower anxiety and agitation levels than the control group. Regarding haemodynamic variables, a significant time trend and interaction was reported between time and group (p<0.001). A significant difference was also found between the anxiety (p<0.002) and agitation (p<0.001) scores in two groups.
  
  
  CONCLUSIONS
  Nature-based sound can provide an effective method of decreasing potential adverse haemodynamic responses arising from anxiety and agitation in weaning from mechanical ventilation in coronary artery bypass graft patients. Nurses can incorporate this intervention as a non-pharmacological intervention into the daily care of patients undergoing weaning from mechanical ventilation in order to reduce their anxiety and agitation.
authors.affiliation: Department of Nursing, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran. Electronic address: bahman.aghai@gmail.com.
authors.forename: Bahman
authors.initials: B
authors.lastname: Aghaie
authors.affiliation: Department of Nursing, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran. Electronic address: reje@shahed.ac.ir.
authors.forename: Nahid
authors.initials: N
authors.lastname: Rejeh
authors.affiliation: Department of Nursing, Faculty of Nursing and Midwifery, Shahed University, Tehran, Iran. Electronic address: heravi@shahed.ac.ir.
authors.forename: Majideh
authors.initials: M
authors.lastname: Heravi-Karimooi
authors.affiliation: Behavioral Sciences Research Center (BSRC), Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic address: ebadi1347@bmsu.ac.ir.
authors.forename: Abbas
authors.initials: A
authors.lastname: Ebadi
authors.affiliation: Behavioral Sciences Research Center (BSRC), Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran; Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Electronic address: t.moradyan@yahoo.com.
authors.forename: Seyed Tayeb
authors.initials: ST
authors.lastname: Moradian
authors.affiliation: Faculty of Professional Studies, University of Nordland, Bodø, Norway. Electronic address: mojtaba.vaismoradi@uin.no.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Vaismoradi
authors.affiliation: College of Human and Health Sciences, Swansea University, Room 142, Vivian Tower, Swansea SA2 8PP, United Kingdom. Electronic address: m.a.jasper@swansea.ac.uk.
authors.forename: Melanie
authors.initials: M
authors.lastname: Jasper
mesh_terms: D001007:Anxiety / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000628:therapy*; D012121:Respiration, Artificial; D013016:Sound; D015300:Ventilator Weaning
keywords: Agitation; Anxiety; Coronary artery bypass; Nursing; Respiration; Sound