Evaluating Pictures of Nature and Soft Music on Anxiety and Well-Being During Elective Surgery

Elinor Nielsen1, Ingrid Wåhlin2, Gunilla Hollman Frisman3, *
1 Department of Anesthesiology and Intensive Care, Vrinnevi Hospital Norrköping, Norrköping, Sweden
2 Research Section, Kalmar County Council, S-391 85 Kalmar, Sweden and Linnaeus University, Faculty of Health and life Sciences, Växjö, Kalmar, Sweden
3 Department of Anesthetics, Operations and Speciality Surgery Center and Medical and Health Sciences, Division of Nursing Sciences. Linköping University, 581 85 Linköping, Sweden

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© 2018 Nielsen et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Anesthetics, Operations and, Speciality Surgery Center and Medical and Health Sciences, Division of Nursing Sciences. Linköping University, Gunilla Hollman Frisman, 581 85 Linköping; Sweden; Tel: +46 72 216 70 60; E-mail:



Patients going through surgery being awake often have a sense of anxiety and need support to relax.


The aim of this study was to investigate whether looking at pictures of natural scenery could reduce anxiety and pain and increase relaxation and well-being being awake during the elective surgery.


This three-arm, randomized intervention study consisted of one group viewing pictures of natural scenery, one group listening to soft instrumental music, and one control group without distraction, all adult patients (n=174). The State Trait Anxiety Inventory short form and a visual analogue scale on well-being were used as well as sedation treatment if necessary.


No differences related to anxiety after surgery were found among the three groups. When controlling for the effect of sedative treatment, however, patients without sedation had a lower degree of anxiety postoperatively (p=0.014). Younger patients had a higher degree of anxiety and lower degree of postoperative relaxation and well-being.


Viewing pictures of natural scenery while being awake during elective surgery is as relaxing as listening to soft instrumental music. Offering nature scenery pictures for patients to view could be relaxing during the elective surgery.

Keywords: Anesthesia, Awake, Distraction, Intervention, Music, Pictures.