Abstract
Moving upstairs or down the hall from the lobbies and common areas, we find that function continues to be the priority, by necessity, and there are fewer options for creating a pleasing ambience. We encourage families of the sickest patients to bring in items from home; quilts, blankets, family photos, flowers, plants, stuffed toys, and other items begin to soften the institutional appearance of the patient's room. We close the door, attempt to keep the area quiet, and post icons to alert staff about a need for privacy and minimal interruptions. Shielding the very sick or dying patient from unpleasant sights, smells, and noise is difficult to orchestrate.
I spent two nights in a hospital a year ago in a private room at the farthest end of the hall from the central nurses' desk (by prearrangement) after elective surgery. My only control of the lights was “on” or “off” (bright fluorescent or dark), and I could control noise by closing my room door, which muffled but did not eliminate the unit noise. I failed to bring my iPod to the hospital because I had expected only a one-night stay and that the effects of anesthesia and analgesics would help me accommodate to my nonhome environment. By the second night, completely alert and no longer under the influence of strong medications, I wakened repeatedly to innumerable unit noises and began counting the hours until I could go home and regain control of my environment.
It may not be feasible to reduce institutional noises due to the complexity and number of individuals involved. Thus, investigators at the MD Anderson Cancer Center explored preferences for background music versus ordinary sound in cancer patients, family caregivers, and health care staff on the inpatient palliative care unit and in the supportive care clinic. 3 Soft, relaxing instrumental music without voices, including jazz and classical music, was played during the day in corridors, at the desk, and in family or waiting rooms. Music was audible to inpatients if their room door was open. Patients, caregivers, and staff preferred background music to ordinary sound; differences in preferred music style were noted according to demographic characteristics. The authors emphasized that patient music style preferences, should be considered if music is used for patients.
As I read this carefully designed prospective study I imagined a very sick or dying patient who is too weak to protest or stop an unwanted music choice. I would be annoyed (very annoyed) if I was subjected to country music and could not get away or turn it off; no offense intended to country music aficionados. Hence, clinicians seeking to translate these findings must consider both an identification of the patient's music preference and a means of detecting when the music is annoying rather than soothing. I'll close with an important quote from the movie Blues Brothers: 4
Elwood: “What kind of music do you usually have here?”
Waitress: “Oh, we got both kinds. We got country and western.”