Nursing Practice and Music Therapy

Nowadays, most medical care relies heavily on pharmacological therapies to cure diseases. Pharmacologic therapies for a chronic or incurable spectrum of illnesses are generally employed for symptom management and control rather than therapeutic aims. Yet, the use of pharmaceutical therapy can be a considerable burden for patients to bear, particularly in disorders with a long-term or chronic natural course.

For select patients who benefit from this type of therapy, music therapy is defined as an alternate and adjunctive method of non-pharmacologic therapy. Music therapy is a relatively new form of therapy, and its effects are continuously being identified. The music therapy’s main known benefit is its effect on stress and the neuronal circuitry. Stress both physiological and psychological is usually the result of an illness. The increase in stress hormones during stress can increase the length of the illness and further reduce immunity. Music, therefore, has proved beneficial in reducing stress levels, reducing the amount of cortisol in the body, boosting the immunity by increasing the release of immunoglobulins, natural killer cells and other cytokines and general mood improvement for ailing patients (Chlan, 2013).

Therefore, the current practice of overreliance on pharmacologic therapy is counterintuitive. Different forms of therapy used together can effectively help improve the outcome of patients and even makes their stay in the hospital more pleasant.

Key Stakeholders Determining Nursing Practices

The Payers

These are the main individuals responsible for paying for the utilities, facilities and major health care provisions. This category can be wide enough to include government and government agencies. In the case of alternative forms of therapies, it is important to incorporate therapies that are sanctioned for use by legislation. Second, it is important to involve insurance companies such as Medicare and Medicaid for payment of some of these alternative and experimental therapies. These tend to be expensive especially due to the new skill level required.

The Employers

This group also includes hospital administrators. They are responsible for beginning a hospital culture that incorporates both pharmacologic and non-pharmacologic regimens into the hospital therapy plan. Their involvement is important for the formation of hospital protocols the identify key demographics that can gain from the incorporation of music therapy into their general health plan. This group is also responsible for employing key personnel trained in the execution and delivery of these new forms of therapy.The Health Care Providers

They include healthcare professionals and clinical research professionals. They are directly responsible for availing the proper forms of treatment to the patients. For this to be effective, the treatment must be based on evidence-based research. They must also have received proper training on how to implement the therapy and the patient groups that would benefit most from the different forms of therapy.

Evidence Critique Table

Source

Evidence Strength (1-7) and Evidence Hierarchy

1. Bringas, M. L., Zaldivar, M., Rojas, P. A., Martinez-Montes, K., Chongo, D. M., Ortega, M. A., & Vera, H. (2015). The Effectiveness of Music Therapy as an Aid to Neurorestoration of Children with Severe Neurological Disorders. Frontiers in Neuroscience, 9.

Level III and Experimental Study

2. Loewy, J., Stewart, K., Dazzler, A. M., Kelsey, A., & Homely, P. (2013). The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants. Pediatrics, 131(5), 902-918.

Level II and Randomized Clinical Trial

3. Raglio, A., Attardo, L., Gontero, G., Rollino, S., Groppo, E., & Granieri, E. (2015). Effects of Music and Music Therapy on Mood in Neurological Patients. World Journal of Psychiatry, 5(1), 68.

Level 1 and Systematic review

4. Nizamie, S. H., & Tikka, S. K. (2014). Psychiatry and Music. Indian Journal of Psychiatry, 56(2

Level 1 and Systematic Review

5. Liu, X., Burns, D. S., Hilliard, R. E., Stump, T. E., & Unroe, K. T. (2015). Music Therapy Clinical Practice in Hospice: Differences Between Home and Nursing Home Delivery.

Level 3 and Experimental Study

Evidence Summary

The true physiologic mechanism in therapeutic music is yet to be fully understood. However, its effect on neuronal circuitry as evidence has proved irrefutable. It activates limbic, amygdala and hippocampus structures which are areas of the brain that are associated with emotion, expression, memory, learning and communication. Therefore, the true physiologic effect of music on the brain structures may be varied and possibly have multiple implications (Raglio, 2015).

The Benefits in Pediatrics

The effectiveness of music therapy is largely dependent on the ability of the health professional to choose specific music that stimulates specific neuronal circuits. In the setting of a Neonatal Intensive Care Unit, music therapy is proving advantageous in the holistic care of both ill term and preterm infants. Preterm infants benefit from music therapy because it improves neurological development and increases the infant's sensory regulation. Loewy et al. (2015) found that this effect is increased in the cardiac and respiratory function. Thus, in the end, appropriate music therapy can improve feeding, sucking behaviors and align vital signs.

The Benefits for Neurological Disorders

The benefit of neurologic music therapy(NMT) is a large promising field. However, the evidence for the true benefits of in neurophysiological changes induced by NMT and its value across different age groups and demographics is largely lacking (Bringas et al., 2015). Neurologic Music Therapy as an adjunct to standard neurorestorative therapy is highly effective in improving the neuro-plasticity of a growing brain. Thus, it is beneficial for children with an array of neurophysiologic disorders and ultimately aids in the improvement of communication, attention, and rehabilitation of other cognitive functions.

In Autistic spectrum disorders, music therapy has been shown to improve the emotional component, communicative cues, expressive cues, socio-behavioral skills and overall learning and memory enhancement (Bringas et al., 2015). This is primarily because children with autism still have their musical effect retained. Thus, through the use of different modalities employing rhythm, pitch, tone, lyrics music therapy targets this communicative and learning difficulties.

The Benefits in Psychiatric Patients

The benefits of Musical therapy have been found mostly in chronic psychiatric illnesses as compared to acute psychotic episodes. In schizophrenia, for example, an improvement in negative symptom was observed in the use of musical therapy. In the case of dementia presenting with mood alterations and psychiatric manifestations, music therapy was used to stabilize mood alterations and improved communicative ability in these patties (Nizamie & Tikka, 2014).

Neurologic conditions such as Parkinson’s or Alzheimer frequently present with psychiatric manifestations such as hallucinations, depression, psychoses, and dementia (Liu et al., 2016). These patients end up requiring either psychiatric or long-term nursing care. These symptoms have been shown to benefit from adjunctive music therapy. It has been shown to improve depression, anxiety, enhance communication and memory. It also improves expression and therefore finer personal skills. This greatly helps alleviate patient symptomatology as well as functional aids recovery (Raglio et al., 2015).

Best Practice Regarding Music Therapy

Best practice describes clinical methods or procedures developed to implement and monitor a health care practice. They are developed from evidence-based research, epidemiology and health services. Currently, best practice guidelines for music therapy are not well formed. However, the following seven general principles should be followed in both research and clinical practice to allow congruence in the delivery of music therapy.

First, there should be an intervention hypothesis. The reason for using music therapy should be specifically described. This includes both the theorized mechanism of action as well as the theorized expected outcome. This portion should include a proper assessment of the patient to see if they meet the required inclusion criteria, and the possible risks and as well as benefit from the proposed intervention.

Second, there should be a comprehensive description of the intervention content and intervention strategies involved. In music therapy, specific music has been shown to be beneficial to specific target groups. Therefore, there is a need to accurately describe the music chosen, including genre, lyric content and sheet content. Further, there should also be a well-documented description of who chose the music and whether it was tailored to the patients need.

Third, a description of the therapeutic intervention schedule. That is, how long the entire intervention will take. With specificities such as time of day, the length of sessions and frequency of sessions within the week should be carefully outlined.

Fourth, a detailed description of the interventionist. This should include professional title, professional clinical and academic credentials and those involved in administering the therapy. This is important as music therapy should be a multi-disciplinary approach where a licensed music therapist works with other clinical professionals to provide the bees care to a patient.

Fifth, is to ensure proper protocols are followed during the intervention. This includes proper supervision, monitoring and proper follow-up of laid down health or administrative protocols.

Sixth, is choosing the proper setting. In music therapy for proper communication and delivery of the music content, the setting of the intervention is key. Therefore, factors such as the site of delivery, the ambient sound around the site and the privacy level, are key factors that should be factored in.

Lastly, the target of the intervention should be clearly described. That is, whether it is an individual or group, and if it is a group, the size of the group should be clearly outlined. The qualification criteria, description of the patient’s medical condition and congruence of medical disorders (if it is a group scenario) should be clearly outlined.

Music Therapy and Nursing Practice

From the above principles, Music therapy as a routine intervention part of nursing care requires proper backbone. This backbone first requires proper training of the nurses involved, who should be trained in non-pharmacological means of treatment, music therapy and well informed on relevant intervention protocols and guidelines (Chlan, 2013). Further, the nurse has to properly versed in pre-assessing the client situating the client, providing the whole treatment and should be committed to being present/ available throughout the delivery of the treatment (McCaughey et al., 2014).

Practice Change Model

The Rosswurm and Larrabee’s Model qualifies as an effective way of incorporating evidence-based change into the system. It is a five-step process that can be fitted into a larger evidence-based change framework. This model is appropriate as it is aimed at integrating evidence-based practices into a health care delivery system.

The model has several advantages. First, it incorporates both data from the hospital set up as well as data from external research. This allows the streamlining of health care standards and best practice guidelines with other health care organizations. Second, it allows the streamlining of standards and the ability to replicate the outcomes from therapeutic interventions. Third, it allows incorporation of clinical management, health care standards with evidence-based results. Lastly, it integrates a component that allows future monitoring of results and is flexible enough to allow incorporation of other evidence-based changes through diffusion strategies.

Application of The EBM Model into The Music Therapy Intervention

First, it is important to assess whether there is a need for a change in practice. In this case, it is aimed to integrate non-pharmacologic forms of treatment to the standard medical care. This allows holistic care to the patient and improves functional recovery. It is important to tailor music therapy to specific patients in the hospital who would benefit most from the intervention (Lok, 2013).

Second, it is important to project outcomes from the intervention. In music therapy this wholly dependent on the patient selected. For instance, the neural spasticity of infants allows music therapy to have a bigger impact (Lok, 2013).

Third, every intervention should be coupled with best evidence practices to replicate good outcomes. Music therapy evidence-based research has proved particularly useful in specific target groups such as pediatrics, psychiatric, neurologic and hospice departments (Liu et al., 2016).

Fourth, design practice change that incorporates input from both hospital administrator as well as clinical personnel in the hospital. Protocol or guidelines should be created in this case that will ease the practice into an understandable practice. These protocols should be implemented and staff trained accordingly. For instance, nursing personnel should be adequately trained in the practice.

Lastly, integrate music therapy into the culture and the general practice of the hospital. This practice should be maintained and improved upon as needed from the and more up-to-date growing evidence based research on the practice.

Barriers to The Implementation of Music Therapy Intervention

The practice of incorporating nonpharmacologic methods of treatment is still largely uncharted in the country. These treatments do not get the same level of funding or interest as standard pharmacological and surgical forms of treatment. Therefore, the integration and maintenance of the practice may be made difficult especially if the outcomes of the intervention are not as profound or as quick as pharmacological forms of treatment.

Currently, there are Equivocal findings from different bodies of research on Music therapy. This is particularly so in specifications on the particular type of patients who benefit most from Music therapy. Coupled, with the fact that complete understanding of the physiologic mechanism of music therapy on physiology, is still largely elusive. These two main points make the creation of standard guidelines for best practice about Music therapy still hard to achieve for most organizations. These organizations depend on this guidelines and protocols to implement the best level of care for their patient.

The initial workforce costs may be expensive. The implementation of the Music Therapy Practice may require the employment of music therapists to consult for the interventions. Second, there must be a clinical practitioner with both academic and clinical practice in Music therapy. Further, it may require training of personnel such as nurses and rehabilitation therapists to be able to aptly implement and continue maintaining the features.

The program may also require significant capital to invest in facilities, equipment, and even location viable or the Music Therapy Intervention. This is especially the case in the performance of live music therapy which is sometimes more suited for specific medical conditions. Therefore, it may require the purchase of musical instruments, private suites building of sound proof facilities into the hospital or put in features that allow filtering of sound.

The patients, as well as the family of the patients, may be opposed to the integration of non-pharmacologic methods of treatment for the standard forms of therapy. This is especially if music therapy is not catered for by their insurance providers or still considered as a trial form of therapy.

Ethical Implications Regarding Music Therapy

Music therapy should be practiced by licensed and certified music therapist with both an academic and clinical background. This ensures that no potential harm comes to the client by an application of less than approved musical therapy intervention. Further, there needs to be set mechanisms that allow for referral and consultation in a case to ensure that the form of therapy given is medical sanctioned.

In the case of applying music therapy in neurology and psychiatric disorders, some people with the disorder feel that it is not addressing the stigmatization issues faced with these disorders rather it perpetuates the need of people suffering from these conditions to try to fit into the normal mold.

An important ethical issue that arises from medical therapy is whether the nonpharmacological treatment should be subjected to the same guidelines as other forms of treatment. That is consent, confidentiality, and knowledge of benefits and risks. The complete knowledge benefits and risks may not be possible as the evidence base is still growing on this front. Confidentiality especially in cases where music therapy is used at the end of life setting or a hospice setting. It is important to hold music therapists to tee same confidentiality principles that are expected of every other medical professional. These facets help in establishing consent from a client. An important ethical implication is whether a patient is allowed to choose its use especially if the intervention is integrated into an organization or in scenarios where the client cannot advocate for themselves such as infants (Biellenick & Ghelli, 2016).

The motivations behind a musical therapist’s music selection may have ethical implications. Music has an ability to evoke emotions. However, the motivations behind a musical section for therapy should be less about the emotional effect and more about the maximum benefit to the patient’s clinical, physiologic outcome. It is also important to tailor these needs to individual client needs and change accordingly as needed.

References

Bieleninik, Ł., Ghetti, C., & Gold, C. (2016). Music therapy for preterm infants and their parents: a meta-analysis. Pediatrics, e20160971.

Bringas, M. L., Zaldivar, M., Rojas, P. A., Martinez-Montes, K., Chongo, D. M., Ortega, M. A., ... & Vera, H. (2015). The effectiveness of music therapy as an aid to neurorestoration of children with severe neurological disorders. Frontiers in Neuroscience, 9.

Chlan, L. L. (2013). Music therapy as a nursing intervention for patients supported by mechanical ventilation. AACN Advanced Critical Care, 11(1), 128-138.

Liu, X., Burns, D. S., Hilliard, R. E., Stump, T. E., & Unroe, K. T. (2015). Music therapy clinical practice in hospice: Differences between home and nursing home delivery.

Loewy, J., Stewart, K., Dazzler, A. M., Kelsey, A., & Homely, P. (2013). The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics, 131(5), 902-918.

Lok, J. G. (2013). Nurses’ Awareness of and Intention to Use Music Therapy in Practice (Doctoral dissertation, University of Toronto).

McCaffrey, R., & Locsin, R. C. (2014). Music listening as a nursing intervention: a symphony of practice. Holistic nursing practice, 16(3), 70-77.

Nizamie, S. H., & Tikka, S. K. (2014). Psychiatry and Music. Indian Journal of Psychiatry, 56(2

Raglio, A., Attardo, L., Gontero, G., Rollino, S., Groppo, E., & Granieri, E. (2015). Effects of music and music therapy on mood in neurological patients. World journal of psychiatry, 5(1), 68.