Music in Health & Healing

Transcription

1 Music in Health & Healing Linda Chlan, Ph.D., RN Associate Professor, School of Nursing University of Minnesota Annie Heiderscheit, Ph.D., MT-BC, FAMI, NMT Graduate Faculty, Center for Spirituality & Healing University of Minnesota

2 Experiential Exercise Live music for learning readiness

3 A Brief History of Music in Healing Practices The concept of music as a healing agent is documented in the writings of Aristotle and Plato Primitive tribes and cultures utilized music based rituals as a part of their healing practices Through the Middle Ages ( ), Boethieus wrote of his views on music & the body Through the Baroque Era physicians prescribed music to their patients

4 Music in Healing Practices Through late 1800 to 1930 s several individuals physicians and musicians alike were writing articles on the healing effects of music Following WWII amateur and professional musicians performed in VA hospitals around the country In the late 1940 s key individuals began to meet to organize a national music therapy organization The first music therapy academic training program was established in 1950

5 According to the American Music Therapy Association (AMTA)

6 Music Therapy is An established healthcare profession that uses music to address physical, emotional, cognitive, and social needs of individuals of all ages. Music therapy improves quality of life for persons who are well and meets the needs of children and adults with disabilities or illnesses.

7 Music Therapy Approaches Neurological Music Therapy (NMT) Improvisation Music Therapy Nordoff Robbins Approach Analytical Music Therapy Bonny Method of Guided Imagery and Music (BMGIM) Medical Music Therapy

8 Examples of Neurological Music Therapy Clinical applications of NMT: - Head injury & stroke patients - Greg (28) dance instructor with closed head injury; in physical rehab - Henry (82) stroke survivor; undergoing PT to address gait training

9 Examples of Bonny Method Guided Imagery in Music (BMGIM) Clinical applications of BMGIM: - Chemical dependency treatment (Gary) - Eating disorder treatment (Erin)

10 Music Intervention From a nursing perspective, a music intervention is the use of music for therapeutic purposes to promote patient/client health and well-being (Chlan, 2006)

11 Music therapy interventions are designed to: Promote wellness Manage stress Alleviate pain Express feelings Enhance memory Improve communication Promote physical rehabilitation

12 Uses of Music Interventions Decrease stress and anxiety Decrease disruptive behaviors Pain management Facilitate relaxation Provide distraction Provide stimulation

13 Characteristics of Music Therapy & Music Medicine

14 Music Therapy & Music Medicine Music Relationship through the music Music Therapist Assessment process Evaluation Goals Process Music Self-selected or preselected music Assessment process (sometimes) Evaluation (sometimes)

15 Types of Music Experiences Utilized Music Therapy & Music Medicine Receptive Improvisation Re-creative or Active Composition Activity based Combined Arts Receptive

16 Case Example Arrian and the Goodbye

17 Movement Break

18 Music Intervention Research from Nursing and other Disciplines Symptom management Pain, distress, anxiety, depression Procedural distraction Behavior; milieu enhancement

19 Music Intervention Methods in Nursing Research Passive Music listening Prescribed versus music choices Equipment CDs MP3 Headphones vs. ear buds Free-field Piano, harp Use with caution in certain settings!

20 Symptom Management Physiological parameters; relaxation; stress Conrad, Niess, Jauch, et al., 2007 Pain Ikonomidou, Rehnstrom & Naesh, 2004 McCaffrey & Locsin, 2006 Distress & Anxiety Richards, Johnson, Sparks & Emerson, 2007

21 Symptom Management Live music during chemotherapy (anxiety, reactions, relaxation) Ferrer, 2007 Fatigue Mansky & Wallerstedt, 2006 Hilliard, 2006 Mood/Depression Giaquinto, Cacciato, Minasi, Sostero & Amanda, 2006

22 Procedural Distraction C-clamp application with femoral sheath removal after percutaneous coronary interventions Chan, Wong, Chan, Fong, Lai, et al., 2006

23 Behavior; Milieu Management Agitation Young adults with autism Boso, Emanuele, Minazzi, et al., 2007 Dementia behaviors Goodall, 2005 Hicks-Moore, 2005 Sung, Chang, Lee & Lee, 2006

24 Milieu and Behavior Management Thomas & Smith, 2009 Integrating familiar music in a dining room for residents with Alzheimer s disease Issues with mealtime stress and behavior Food consumption and caloric intake were analyzed over 24 weeks with and without music Music was played in the background

25 PROTOCOL N = 12 residents; average age = 83.5 Traditional American folk melodies, popular classical, traditional English and Irish folk melodies, 13 th century English dance music with a relaxed tempo Played during lunch time in the background

26 RESULTS Caloric intake increased by 20% during music exposure Increased consumption of carbohydrates Attentive to and consuming dessert Residents were observed tapping their feet, singing and humming with positive verbal and non-verbal behaviors displayed Psychological absorption in music decreased stress

27 Music Therapy in Neuro- Rehabilitation Music is an innate ability in all humans Social medium: Central role in group experiences such as singing, dancing, ritual and spiritual expression Music facilitates emotional responses and conveys feeling states Music promotes neuroplasticity; neuronal connections»from Magee, 2009

28 Music + Other Therapies Stress reduction for nursing staff through an artsin-medicine program Repar & Patton, 2007 Music-assisted relaxation + imagery for cardiac rehabilitation Mandel, Hanser, Secic, & Davis, 2007 Music + aromatherapy massage on anxiety and stress or ER nurses Cooke, Holzhauer, Jones, Davis, Finucane (2007) Music + acupuncture to promote relaxation and improve quality of life in patients with HIV Chang, Boehmer, Zhao, Sommers, (2007)

29 Directions for Future Research Music intervention tested over > one session Live versus recorded music? Need for careful design of intervention and control condition(s); selection of outcomes Sample size estimation based on power analysis calculations Conceptual model testing & development Consultation with a music therapist?

30 When to Consult a Music Therapist When patient needs music preferences assessed If needs for music intervention move beyond receptive/listening approaches When music is bringing up feelings, thoughts or emotions that may require therapeutic intervention When a patient demonstrates specialized needs

31 Nursing + Music Therapist Collaboration

32 Nursing and Music Therapy Research study as an exemplar of professional, interdisciplinary collaboration

33 Multi-disciplinary Research Project Each discipline contributes expertise to the care of complex, critically ill patients Multi-disciplinary research team; science - Nursing - Medicine - Pharmacy - Music therapy - Biomedical engineering Neuroendocrine physiology Biostatistics

34 STUDY BACKGROUND: Critically ill Mechanically Ventilated Patients Anxiety self-management for patients receiving ventilatory support 1.5 million+ patients receive ventilatory support outside of operating rooms in the U.S.; increasing Physiological & psychological distress Need for adjunctive interventions to manage anxiety

35 WHY MUSIC? Meaningful, comforting, familiar stimulus for most people Does not require focused concentration to be effective Effective in reducing anxiety in surgical and coronary care unit patients

36 Overview of Study Protocol Patient-directed music intervention (experimental condition) Control conditions: Headphones, Usual care Role of the music therapist - Assessment of music preferences - Music collection for subjects - Coaching of subjects & nursing staff ---Research team development

37 Music Assessment Tool (MAT) Revised version of the Music Assessment and Intervention Tool (MAIT) - Chlan & Tracy, 1999 Revised by Dr. Heiderscheit 2006 for purposes of standardized assessment for research protocol Chlan, L. & Heiderscheit, A. (2009). A tool for music preference assessment in critically ill patients receiving mechanical ventialtory support. Music Therapy Perspectives, 27(1),

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39 Case Example David

40 Case Example Scott

41 Case Example Bob

42 Case Example Patty

43 What have we learned to date? Preliminary findings for anxiety Importance of continuous assessment of music preferences Changes in preferences over the course of ICU stay Preferences change depending on health status Anecdotal comments and observations

44 Summary & Conclusions Assess music preference for one-on-one interventions Consult a professional music therapist Importance of interdisciplinary collaborations Outcomes of interest Patient/client perspectives Research is growing

45 QUESTIONS or COMMENTS?

46 Experiential Exercise Drumming