- freely available
Medicines 2019, 6(1), 12; https://doi.org/10.3390/medicines6010012
1.1. The Value of Music and Singing for Health and Wellbeing
1.2. Theoretical and Conceptual Framework
1.3. Gaps in Knowledge
1.4. Purpose and Aim
2. Materials and Methods
2.1. A Qualitative, Cross-Sectional Case Study
2.2. Data Collection and Analysis
2.3. Planning the Music-Based Environmental Intervention—The “Myskja Model”
- Acquire knowledge of different mapping tools that are used to systematize individual customized music therapy. This may, for example, be an assessment of music preferences.
- The act of mapping involves (i) mapping the patient’s relationship with music; (ii) using prerecorded compact discs (CDs) which contain snippets (mostly 50% of each track) of different musical pieces within different genres; (iii) mapping music preferences using a standardized form; (iv) setting up individual music programs (what to listen to) or group-based music programs (songs or participating in singalongs or attending concerts); (v) developing measurement/evaluation (tools); (vi) documenting (filling in a form or writing a log to be inserted in the patients’ individual care plans).
- Gain experience in gathering up-to-date knowledge, and assessing and communicating this knowledge.
- Participate in/take responsibility for designing a method of measurement related to music therapy, in the latter part of the practice period.
- Attempt to document and evaluate the effect/non-effect of this treatment, as well as make an assessment for further follow-up.
- Examine the relationship between systematic music therapy and the clinical assessment process.
- Acquire knowledge of different mapping tools that are used to systematize individual customized music therapy. This may, for example, be an assessment of music preferences.
- Further develop expertise in music therapy and planning, and mapping selected patients, ongoing evaluations, and follow-ups.
- Further develop the competences of assessing, facilitating, and communicating current knowledge from various sources back to daily practice.
- Try to establish and use electronic patient records.
- Further develop competence by supporting the student in training on assessing and communicating knowledge in connection with music therapy.
3.1. From a Period of Confusion to Increasing Awareness of Music’s Power
The nursing students were interested, and completed and documented with very good results. A student took action with a patient with long-suffering dementia and then said that this was their best experience throughout the practice period, and the experience was very positive.(Veronica, supervisor)
“It’s amazing to see how songs could work as painkillers”.(student)
When you see it can work, it makes everyday life easier for you and the patient. Often, instead of medicines, I mean, sometimes we wanted to try music instead of medicines.(student)
Yes. For her, we found how it works best. She [the patient] increased her quality of life by appreciating listening to music… when we were making a playlist for her, she almost started crying because she was so happy that she should have a playlist with music that she could hear when she wanted to… so it may change your mood, I noticed it; special songs give totally different feelings.(student)
“It was one morning, I remember, when she [the patient] was very upset… then, I sat down and sang with her… and then she was at ease for a long time. I saw this quite often”.(Mona, student)
I am pleasantly surprised, I had no expectations, I never thought I would like to enjoy my job so much, I never thought I would find such a wellbeing, but I have found that.(Lisa, student)
My patient is 90 years old, struggling with boredom in the evening and sitting and pushing the clock all the time; so, I thought we had to find something to do, so we went through the CDs and it was very positive and suddenly she just lived… and she started singing, jazz, and dancing, and then there was a completely different side of the patient suddenly, and, now, relatives are going to fix the CD player for her, she is very fond of typically Norwegian music as long as the songs are not too slow.(Freddy, student)
We arranged a dance festival event lately. Then, they came from the whole department. Everyone seemed to enjoy themselves very much, but it was one thing I noticed. One who has Parkinson’s and has trouble just getting out of bed, he danced swing with me three songs in stretch! And it’s solely because of music, dancing Mazurka.(Alfred, student)
3.2. Barriers and Success Factors on Implementing the Music-Based Intervention
We thought the students would guide us and they thought we would guide them.(Sarah, supervisor)
I had supervisors who did not at all know what to do. I did not get help. I’ve used music for patients who had a lot of uneasiness and anxiety. A patient said that she would go home and visit her mother-in-law and, when we locked the door, she was sad and crying. Then, I used music to calm her and to reduce her confusion. We used her CDs. I had little information about what kind of music she liked, but I read in the journal and filled in the form what she said she liked.(Emma, student)
We have not really learned so much, we think it was not really well organized… I think we should have had more teaching, and learned more about it [music] first so we could use it more actively… we were thrown into it. We were actually halfway (in practice), but still had not got any more information since we were at our lecture.(Fiona, student)
Yes, it is good that it is health-promoting, but how music also can induce anger or sadness, you have not had a lecture about that, but it can bring memories then.(Roger, student)
Some songs I personally was very excited about gave completely different reactions [for the patient]; one began to talk about her mum and childhood.(Grethe, student)
I would have to figure it out in other ways. One patient said “bad music”, but then she said she liked old fashioned music and then I searched for it. She was very certain of what she did not like.(Hannah, student)
The mapping form (using the CDs from the Myskja model) did not work well, but the patient had many CDs we used. We all played for a patient twice, and tried to catch and observe different reactions. She [the patient] explained herself that different songs gave different reactions, she realized her emotions changed with the mood of the music, giving different associations… she sat still and listened. Different songs stimulate different reactions… that were amazing. Another patient would not listen to the entire CD, but chose the dance band music we had listened to, and she liked it. She got up and danced with me once, and that person really walks with a Zimmer-frame. I’d never thought I would live to see this.(Mary, student)
We were with a patient, who recently moved here, and she had sung in a choir and, through the mapping of her musical choices, we got a good insight into what we could use to prevent uneasiness and turmoil. Once we had gone halfway through the CD and came to rock, country, and dance band, she started telling funny stories, associated and described so well what she thought of and what she dreamt about. Amazing.(Debbie, student)
3.3. Lack of Coordinated Action—The Importance of Management Engagement
It was a bit like this: now we have to start with some music therapy. My supervisor had a lot to do, and regretted that she had not read up on this. Then it’s better to use those who are enthusiastic.(Anna, student)
Yes, it’s a problem that not everyone is as keen.(Susan, counselor)
When someone is negative it’s an infectious mood; what’s also strange is that when those who are negative performed music “under compulsion”, it never worked.(Heidi, counselor)
If we had used the local Myskja contacts more, this would have been much better; but we were not aware of this in advance, so the entire department could follow up and that would be positive. I think we have kindergarten cooperation and the students had been very motivated and thought this was very rewarding. We have not tried this [music-based intervention] systematically before the students arrived. It is not systematized and added to our aims really, and in our action plan, I do not know the reason why the Myskja contacts did not work more with implementation in advance. There are still some who work with us who do not know what this is.(Alice, leader, nursing home)
I think they (management) should have known a little better in advance. What I experience as a problem was that we did not get enough information about what to do. It would be better if we had a clear message of how it should be done. We experienced that our supervisors knew as little as us. We had someone else at the department [not in this project] who had a book we borrowed. We should take some tests beforehand; this should be done by the supervisors beforehand, but it did not happen.(Lisa, student)
4.1. Strengths and Limitations of the Study
4.2. Increasing Awareness of Music’s Power
4.3. Barriers and Success Factors—A Need for Further Knowledge and Training
4.4. The Significance of Interdisciplinary Collaboration—The Value of Engagement
- To acknowledge the unique capacity of music for achieving particular emotional states, the chosen music seems to be related to personal life experiences, contexts, and life phases. Thus, the benefits of self-selected music are a vital feature in music-based interventions.
- The act of mapping musical preferences is vital, but could perhaps be guided by professional music therapists or someone with similar competence to avoid barriers and to aid the implementation and adoption process for all actors.
- If nurses aim to learn how to incorporate music intervention into their practice, theoretical and evidence-based knowledge must be taught by teachers and similar professionals from educational institutions.
- To achieve success and lessen barriers in the implementation of music-based interventions in nursing homes, there needs to be a raised level of commitment, and changes in attitudes and beliefs in what nursing may contain and involve. A solid backing and the use of a professional music therapist or likewise to support and aid this process would possibly contribute to better coordination and heighten the level of engagement and motivation among actors involved for better quality of care.
- To introduce new approaches and methods in healthcare practice is challenging. If management could appreciate how music and singing may enhance a health-promoting workplace for its employees, it might be possible to create a stimulating, rewarding, and thriving psycho-social environment, which would benefit all actors involved.
- Music and “musicking” as a method or strategy in elderly care ought to be included as a vital component for the enhancement of health, wellbeing, and quality of life for patients in nursing homes. This is in line with geriatric care, which recommends non-pharmacological approaches as a complement to conventional care.
Conflicts of Interest
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