Music Therapy and Nursing Care

Afza.Malik GDA

Nursing Care and Role of Music Therapy

Self Efficacy Middle Range Theory in Nursing Care

Music Therapy,Music Therapy Providers,History of Music Therapy,Physiological Impact of Music on Body,Nursing Research on Music Therapy Outcomes,Transformation of Thoughts by Music Therapy,Music Rhythms and Their Impact,Selection of Therapeutic Music,Coordination and Consideration for the Selection of  Music.

Music Therapy

    Music therapy is the use of music for the purpose of improving physiological and psychological health and well-being. For music to be therapeutic, there must be an interaction between the music and the person who desires a health outcome from the music (Meyer, 1956). 

    This implies that there is individual, age, culture, and situation related differences in choice and effect. The saying that music is a universal language gives the false impression that everyone appreciates and is helped by the same music. 

    Although all cultures of the world use music in some form and derive meaning from it, different cultures and different generations are accustomed to listening to widely divergent kinds of music. 

    There may be large differences in volume, pitch, rhythm, tempo, harmony, disharmony, words, and meaning (Cross, 2003). In addition, there is variation within age and cultural groups (Good, Picot, Salem, Picot, & Lane, 2000).

Music Therapy Providers

    Music therapy may be provided by a registered music therapist who has been taught to use music in many therapeutic ways. However, any member of the health care team may suggest to patients that soft music can be helpful for stress, pain, and mood, and can use stimulating music to encourage socialization, expression, and exercise. 

    Nurses can assess musical preferences, offer a choice of selections, and encourage patient involvement in the music with the goal of achieving specific health outcomes.

History of Music Therapy

    Throughout history, music has been used for a variety of therapeutic purposes by primitive people to ward off evil spirits, prevent or cure illnesses, relieve depression, modify emotions, and achieve inner harmony. 

    Early cultures had little means to treat disease, so music and spirituality were used to provide comfort and help people cope. During the Renaissance, physicians became interested in the therapeutic value of music and incorporated it in their training and practice. 

    From the 17th century onward, physicians studied the effect of music on physiology and psychology, and debated whether to focus on the type of music that was effective versus the type of person who responds positively to music. 

    Nightingale used music with injured soldiers in the Crimea. She had recreation areas where recovering, men could go to listen to singing or playing of musical instruments.

Physiological Impact of Music on Body

    At the beginning of the 20th century, the first laboratory studies of the physiological effects of music were conducted on animals and humans. These experiments demonstrated changes in vital signs and body secretions in response to various types of music. 

    They are rejected by most investigators today because of the poor quality of measurement, analysis, and control. In the 1930s music began to be used in patients' hospital rooms, in surgery prior to general anesthesia, and during local anesthesia. Music was used in obstetrics and gynecology to reduce the side effects of inhalation anesthetics.

Nursing Research on Music Therapy Outcomes

    Nursing reviews of research on the effect of music on health outcomes can be found. in chapters by Good (1996), Guzzetta (1988, 1997), Standley and Hanser (1995), and Snyder and Chlan (1999). 

    The American Music Therapy Association and two journals, the Journal of Music Therapy and Music Therapy Perspectives, are excellent resources.

Transformation of Thoughts by Music Therapy

    Music can transport patients' thoughts to a new place, give them new perspectives, lift their mood, provide comfort, familiarity and pleasure to patients, and stimulate memories, meanings, and self-insight.     

    In addition, studies have shown that music reduces pain and anxiety, reduces muscle tension, raises levels of beta endorphins, and lowers adrenocorticotropic stress hormones. 

    Music has been found to improve the immune system, salivary cortisol, postoperative and cancer pain, sleep, nausea and vomiting of chemotherapy, mood during stem cell transplantation, pain of osteoarthritis, and cardiac anxiety and autonomic balance. 

    It has also been effective for acute and chronic pain and during stressful or painful procedures (e.g., injections, gastrointestinal endoscopy, and lumbar punctures). Music has been generally found to reduce anxiety before, during, and after surgery, during burn debridement, in chronically ill patients, and after myocardial infarction. 

    It has been studied for circumcision pain in infants, for injection pain in children and adults, for disturbances in psychiatric, demented, and agitated patients, in the critically ill, in dyslexic children, in post anesthesia patients, in the emergency department, and in those who are comatose or dying. 

    Lullabies have shown beneficial effects on preterm infants. A double-blind study of music during surgery showed effects on recovery. In mice, music reduced stress and metastasis and improved immune factors.

Music Rhythms and Their Impact 

    Music has been categorized into stimulative and sedative types. Stimulative music has strong rhythms, volume, dissonance, and disconnected notes, whereas sedative music has a sustained melody without strong rhythmic or percussive elements. 

    Stimulative music enhances bodily action and stimulates skeletal muscles, emotions, and subcortical reactions in humans. Sedative music results in physical sedation and responses of an intellectual and contemplative nature (Gaston, 1951). 

    Recategorizations by the nurse, however, does not consider the kind of subject response. Other ways of categorizing are slow and fast music, or by type of music or instrument.

Selection of Therapeutic Music

    To choose music that is therapeutic, the nurse should consider the nature of the music, the patient preferences, and the health state. 

    Nurses can assess patients' sex, cultural background, musical preferences, music training, participation in music, degree of auditory discrepancy, time available, and, most of all, degree of liking for the music under consideration. 

    Variations in the nature of the health state determine whether music will be used to cheer, encourage, soothe, relax, distract the mind, stimulate exercise, or evoke emotions of joy, triumph, resolve, or peace. 

    Studies have indicated that different kinds of music result in positive or negative feelings and differences in serotonin. Music is economical for patient use. Tapes, compact discs, and players are relatively inexpensive, and a small library can be maintained on any nursing unit. 

    Music piped into patients' rooms also may be available. Nurses can suggest that patients and their families bring in favorite music from home that is likely to invoke healthy responses. They can refer patients to a music therapist if one is available.

Coordination and Consideration for the Selection of  Music 

    There are some contraindications and considerations when using music for patients. Contraindications include hypersensitivity to sound, tone deafness, mucogenic epilepsy, and inability to recognize music in some stroke patients. 

    Nurses should consider any patient dislike for any particular selection or type of music, their inability to turn it off when desired, cochlear implants, and culturally incongruent music. In addition, those with hearing loss may or may not find that listening to music is beneficial. 

    Future re- search in music may include studies that determine the kinds of music that are effective for health outcomes in countries around the world and between cultures in each country. 

    More work on comparing symptomatic response with physiological response is needed to generate theories of conditions in which music is effective, how it affects body processes, and what effect it has on recovery, immune function, and health.

    Music brings an air of normalcy, entertainment, pleasure, and escape into a world where illness is often the enemy and both patients and caregivers are fighting back. Music is an integral part of most people's normal lives and should not be forgotten when they go to hospitals and other health care facilities. 

    With the increased reliance on technology in health care today, music can add a humanistic touch. Beyond the humanistic value of music is the therapeutic value in reducing stress, pain, anxiety, and depression and promoting movement, socialization, and sleep.

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