Music is widely recognised for it’s psychological and physiological benefits, however music therapy is expensive to implement on a wide scale in a clinical environment. With advancements in technology there is scope to broaden the use of non-pharmacological treatments at a low cost.
Initially a 24 hour loop of music will be created proven to improve mental health, promote relaxation and extend sleep duration. It will include a combination of classical, ambient music and recordings from natural environments such as woodland birdsong or the sound of the ocean. The music will consistently have a low tempo to promote relaxation. It shall be pleasingly harmonic to create a positive mood and promote calmness. It shall contain few instruments playing at the same time, therefore remain simplistic and easier to focus on. There will be few if any traditional rhythmical elements to the music, i.e. no drumming. It shall contain long, sustained notes to promote focus and to prevent disruption due to sudden changes. The timing shall remain mathematical and predictable to prevent disturbing patients and promote relaxation due to pattern and consistency. Content of the channel shall be confirmed appropriate by working alongside qualified music therapists and other medical professionals who have expertise in the area.
From conducting literary research and my experience working in Complex Care and other wards in hospitals, the channel will help with the following patients and situations.
Dementia patients
When a dementia patient is experiencing hallucinations that causes anxiety or agitations, calming auditory stimuli has the potential to alter the hallucination to one that is not stressful for the patient. This can be achieved by the mood altering effects of music (Leubner et al 2017) or by utilising recordings of calming natural environments such as birdsong from a British woodland. The latter may act by altering the perceived environment the hallucination is taking place, thereby removing the patient from the stressful situation. For example, I’ve witnessed a patient believing they are at home looking for their wife until I played them the sound of the ocean. This changed their behaviour as they started to speak as if they were at the beach. Therefore the patient no longer had such a strong association for their wife to be present. This kind of recording may also act to provide an alternative focus, distracting the patient from repetitive thought patterns frequently observed in dementia patients.
During my time in healthcare I have witnessed the following initiate agitation, anxiety and disturb sleep in Dementia patients: call bells and other alarms from hospital equipment (IV drips, Observation Machines, telephones etc.), distressed noises from other patients, noises caused by staff working, patients or staff talking, content on televisions. Having a source of relaxing music and sound may help to provide a background noise, to mask the above causes of distress by providing an alternative focus.
The potential benefits for dementia patients are improved mood, reduced aggressiveness, lower anxiety and fewer agitations (Svansdottir et al 2006) (Bishop et al 2018) leading to reduced staff assistance, improved co-operation and reduced dependance on pharmaceuticals (Guetin et al 2009).
Palliative care patients
When a patient no longer has the ability to communicate verbally, providing appropriate relaxing music could help comfort palliative care patients (Warth et al 2015). Although televisions in Hospital do have access to radio stations such as Classical FM, it is not consistently suitable during palliative care as some pieces build to intense crescendo’s which highly stimulates the brain causing the opposite of relaxation. If my channel were to be installed, staff could select the channel and be assured that the content would consistently be appropriate.
Patients experiencing insomnia or those easily disturbed by noise from the ward
I want to curate the channel to consider the time of day. Therefore I would include pieces of music and sound known to promote sleep from circa 8pm to 8am. Not only could this help patients who experience difficulties relaxing prior to sleep, this could help mask the sounds of the ward environment for those that are easily disturbed during sleep (Afshar et al 2016). The potential benefits are: faster recovery, shorter inpatient stays, lower pharmaceutical expenditure, improved hospital experience and mood.
Pre/post op patients
Pre-operative anxiety can adversely affect anaesthetic induction and patient recovery as well as decrease patient satisfaction and perceived quality of care (Thenmozhi et al 2015). Some patients may find listening to relaxing music beneficial in reducing pre/post-op anxiety and pain via distraction, potentially decreasing recovery time and therefore discharge rates (Thenmozhi et al 2015) (Mullooly et al 1988) (Fellner et al 1971).
Depressed and anxious patients
Music is widely recognised for it’s mood altering effects and certain patients experiencing depression or anxiety may benefit from a music channel that features mood lifting, relaxing music and sound (Leubner et al 2017) (Jayakar 2017). The potential benefits include: improved mental health, improved inpatient experience and co-operation, reduced staffing and lower pharmaceutical expenditure.
Mental health patients
Patients experiencing paranoia or schizophrenic episodes may find comfort in the proposed music channel due to the relaxing nature of the content (Gold C et al 2011) (Tang W 1994).
Respiratory and cardiology patients
Relaxing music can activate the parasympathetic nervous system and aid in regulating respiration rate, heart rate and blood pressure (Salamon et al 2003) therefore the channel would be suitable for application on respiratory and cardiology patients.
Conclusion
There are many situations where the addition of a music therapy channel can provide psychological and physical benefits for patients with no side effect risk and a low set up cost.
References:
Bishop, S. J., & Gagne, C. (2018). Anxiety, Depression, and Decision Making: A Computational Perspective. Annual review of neuroscience, 41, 371–388. https://doi.org/10.1146/annurev- neuro-080317-062007
Farokhnezhad Afshar, P., Bahramnezhad, F., Asgari, P., & Shiri, M. (2016). Effect of White Noise on Sleep in Patients Admitted to a Coronary Care. Journal of caring sciences, 5(2), 103–109. https:// doi.org/10.15171/jcs.2016.011
Fellner CH. Alterations in pain perceptions under conditions of multiple sensory modality stimulation. Psychosomatics 1971 Sept/ Oct:313-315.
Guétin, S., Portet, F., Picot, M. C., Pommié, C., Messaoudi, M., Djabelkir, L., Olsen, A. L., Cano, M. M., Lecourt, E., & Touchon, J. (2009). Effect of music therapy on anxiety and depression in patients with Alzheimer's type dementia: randomised, controlled study. Dementia and geriatric cognitive disorders, 28(1), 36–46. https://doi.org/10.1159/000229024
Gold C, Heldal TO, Dahle T, Wigram T. Music therapy for schizophrenia or schizophrenia-like illnesses. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004025. doi: 10.1002/14651858.CD004025.pub2. Update in: Cochrane Database Syst Rev. 2011; (12):CD004025. PMID: 15846692.
Jayakar, J. P., & Alter, D. A. (2017). Music for anxiety reduction in patients undergoing cardiac catheterization: A systematic review and meta-analysis of randomized controlledtrials. Complementary therapies in clinical practice, 28, 122–130. https://doi.org/10.1016/ j.ctcp.2017.05.011
Leubner, D., & Hinterberger, T. (2017). Reviewing the Effectiveness of Music Interventions in Treating Depression. Frontiers in psychology, 8, 1109. https://doi.org/10.3389/fpsyg.2017.01109
Mullooly, V. M., Levin, R. F., & Feldman, H. R. (1988). Music for postoperative pain and anxiety. The Journal of the New York State Nurses' Association, 19(3), 4–7.
Salamon, E., Kim, M., Beaulieu, J., & Stefano, G. B. (2003). Sound therapy induced relaxation: down regulating stress processes and pathologies. Medical science monitor : international medical journal of experimental and clinical research, 9(5), RA96–RA101.
Samson, S., Clément, S., Narme, P., Schiaratura, L., & Ehrlé, N. (2015). Efficacy of musical interventions in dementia: methodological requirements of nonpharmacological trials. Annals of the New York Academy of Sciences, 1337, 249–255. https://doi.org/10.1111/nyas.12621
Svansdottir, H. B., & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer's type: a case-control study. International psychogeriatrics, 18(4), 613–621. https:// doi.org/10.1017/S1041610206003206
Tang, W., Yao, X., & Zheng, Z. (1994). Rehabilitative effect of music therapy for residual schizophrenia. A one-month randomised controlled trial in Shanghai. The British journal of psychiatry. Supplement, (24), 38–44.
Thenmozhi, P (2015). Effectiveness of Music Therapy on Pre-Operative Anxiety among Patients undergoing Cataract Surgery. International Journal of Multidisciplinary Educational Research. 4. 141-147.
Warth, M., Keßler, J., Hillecke, T. K., & Bardenheuer, H. J. (2015). Music Therapy in Palliative Care. Deutsches Arzteblatt international, 112(46), 788–794. https://doi.org/10.3238/ arztebl.2015.0788
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