Nursing Care and Role of Music Therapy

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.