The addition of arts in medicine as a discipline on a clinical unit can positively affected both unit culture and patient care (Sonke et al, 2015). While a musician is not a clinician or a care provider, a musician can be considered a part of the interprofessional care team on an emergency or trauma care unit, as in other areas of a hospital. Clinical staff, including doctors, nurses, and other clinical service providers, may call on a musician to help them address a patient’s needs, including stress reduction and general coping. Musicians must clearly understand the scope of practice appropriate to their role on the team, and maintain appropriate boundaries in the musical services they provide. In some instances where a patient may be displaying significant emotional needs, the musician may refer back to another clinical service provider.
Some general guidelines can assist musicians in acting effectively as a member of the interprofessional team:
The musician must also be aware of unit systems, such as those that protect the safety and privacy of patients and others in the environment of care and those that identify critical activity zones for staff. Musicians, like all members of the interprofessional care team should complete training on the following topics and procedures:
Musicians should always confer with unit staff regarding patients who should or should not be approached for a music interaction. Depending on the practice put in place for the program, the musician may confer with a unit’s charge nurse, unit clerk, attending physician or social worker. These individuals may make recommendations regarding patients who should or should not be visited by the musician.
Generally, an inquiry such as, “Is there anything I need to know before I visit this patient?” will allow a care team member to share any essential information while adhering to patient privacy guidelines. However, in emergency and trauma care units, additional information regarding specific protocols or cautions posted on doorways may be needed. A musician might also ask:
A musician does not need to know a diagnosis or other medical details in order to work effectively with a patient, but the care team should have the opportunity to share any information that might be necessary in regard to patient safety and that might facilitate the most useful and enjoyable interaction. Particularly when caution signs are observed on a door, the musician should inquire about the appropriateness for music and any additional safety precautions that may be needed.
As noted previously, awareness of unit systems is essential for musicians, particularly those that identify critical activity zones for staff or staff members who are engaged in activities requiring a particularly high level of concentration. Music and music programs add to the complexity of the healthcare environment. While it can be a positive distraction, music has also been found to cause negative distraction for staff when it interferes with their work or concentration (Sonke et al, 2015). Musicians must insure that music being played for patients does not interfere with the work of team members. Communication on this issue is important and staff members should be encouraged by the musician to express any concerns related to music in the environment of care.
Many artists describe entering a patient room as one of the most challenging aspects of working as an artist in a healthcare environment. The following guidelines can assist musicians with making an effective and respectful entry into a patient room.
Once in the patient’s space, the musician should introduce him/herself, including the programmatic affiliation (such as with the Arts in Medicine program) and let the patient know that they are there to offer music.
If a patient turns down the offer for music, the musician should gracefully accept the decline and conclude the visit in the most appropriate way, which may include further informal conversation or an immediate exit. Good judgment in this stage of the interaction is essential. It is important for a musician to help patients to feel that they can say yes or no, and to help patients feel comfortable when they say no.
Once it is established that the patient would like to hear music, the musician should ask the patient what style of music they like or if they have any favorite artists or songs that they would like to hear. A musician can ask the patient’s name, but should avoid questions like “how are you?” or “how are you feeling today?” or other questions that could be perceived as clinical in nature.
The musician must also ask anyone else within hearing distance of the interaction if it would be all right for music to be played. While sometimes difficult, this is an essential practice in any clinical environment, particularly an emergency or trauma unit where anxiety levels can be very high. While preferential music may be very helpful to one patient, if it is increasing stress in any way for others in the environment, if should not be introduced. The musician must understand that music can be both a positive distraction or a negative distraction in a clinical environment (Sonke et al, 2015), and take every measure to ensure that everyone exposed to music has consented independently and is likely to experience it as a positive distraction. If playing in a private room, the musician should be sure that the door is closed. If playing in an open environment, the musician should set a volume level that insures that only those who have consented will be exposed to the music.
A patient may provide the musician with a specific request, or may make a vague reference to a musical preference, suggesting that the musician “play anything”. If the patient requests a specific song, the musician should take a moment to mentally review the lyrics of the song for anything that may be inappropriate for the moment, in that it may be too sad, explicit, or too “close to home” in a particular way.
In general, a musician might try to avoid songs that speak of death, loss, or other subject matter that could be overtly negative or emotionally disturbing. Typically, songs that are positive and uplifting lyrically, and that deliver a warm and soothing ambiance simultaneously are most likely to be appropriate.
The following songs and artists are generally accepted by a multitude of patients with great success, however the culture of the surrounding area in which the hospital lies will impact the efficacy of these suggestions. However, a patient may want to hear a song of that nature, and the musician would need to either express a concern to the patient or otherwise find a way to feel clear that the song is indeed appropriate for the moment. This requires good judgment, which seasoned musicians in residence are able to develop. Another option is for the musician to edit lyrics. The musician should let the patient know that they play a slightly different version of the song, and ask it that is all right.
If the musician is unable to fill a patient's request, she might offer other songs that are similar to the one requested. Taking time to suggest different songs may spur a patient’s memory of songs they like and spur a specific request. If a specific song cannot be identified, the musician can try to help the patient identify a genre of music that they enjoy and play a selection from that genre. In selecting a song, the musician might take into consideration the patient’s energy level, the general tenor in the room, or the patient’s general age range and the types of music that may have been a part of their life. The musician should always ask the patient if the song they would like to suggest would be of interest, avoiding surprising a patient with a selection by starting to play it without permission.
The phase one clinical trial conducted in 2014 in the Emergency and Trauma Care Center at the university of Florida yielded lists of the top 20 most requested and most performed (musician selected) songs, artists and musical genres over the 20-week study period. Click here to view the lists.
Musical preference is only one of several important components of performing music for patients in an emergency or trauma unit. The musician must also carefully consider volume, tempo, tonal range, lyric content, and duration of performance and the visit.
After performing one song, the musician should wait for some sort of response from the patient. If the response is positive, the musician may ask of the patient would like to hear another song. This is another moment when musician's judgment is needed. A seasoned musician in residence can often sense when a patient would like to conclude the interaction and when he or she might be receptive to more music.
While performing, a musician must be actively observing the patient and sensing the environment. If any discomfort is observed, the musician should conclude the song and either check in with the patient regarding their comfort with the music or find a way to graciously conclude the interaction and leave the room. It is important to remember that most people want to be polite and hospitable, even in a hospital, and that the artist must make it easy for the patient to decline or conclude an interaction.
In some cases, music can elicit an emotional response from the patient, which may lead to a narrative. In these instances, the artist should continue to hold the space and listen impartially as appropriate, but should not engage the patient in dialogue around emotional issues. Musicians trained to work in healthcare settings are adept at keeping conversation oriented to music as a form or art and enjoyment, without engaging in emotional processes. In some instances, the musician may need to conclude the session and refer the patient to a social worker or other clinical staff member. Good practice for a musician in residence involves a well thought our strategy to quickly and gracefully exit a patient room, should an interaction become inadvertently troublesome to the patient
Once the musical interaction is complete, the musician should thank the patient, exit the room, and complete any infection control procedures necessary before seeing other patients.
Agwu, K. K., & Okoye, I. J. (2007). The effect of music on anxiety levels of patientsundergoing hysterosalpingography. Radiography, 13(2), 122-125.
Aldridge, D. (2004). Health, the Individual, and Integrated Medicine- Revisiting an Aesthetic of Health Care, Eds. Jessica Kingsley Publishers, London.
Aldridge, D. (1994). An overview of music therapy research. Complementary Therapies in Medicine, 2(4), 204-216.
Bauman, B. H., & McManus Jr, J. G. (2005). Pediatric pain management in the emergency department. Emergency Medicine Clinics of North America, 23(2), 393-414.
Bengtsson, S. L., Ullen, F., Henrik Ehrsson, H., Hashimoto, T., Kito, T., Naito, E., ... & Sadato, N. (2009). Listening to rhythms activates motor and premotor cortices. cortex, 45(1), 62-71.
Cepeda, M., Carr, D., Lau, J., & Alvarez, H. (2006). Music for pain relief. Cochrane Database of Systematic Reviews. 2. [DOI: 10.1002/14651858.CD004843.pub2]
Dileo C. Music Therapy and Medicine: Theoretical and Clini- cal Applications. Eds. American Music Therapy Association, Inc. (1999).
Dritsas, A. (2013). Music Interventions as a Complementary Form of Treatment in ICU Patients. Hospital Chronicles, 8(2), 58-59.
Engwall, M. & Duppils, G.S. (2009). Music as a nursing intervention for postoperative pain: a systematic review. J Perianesth Nurs. 24(6):370-83.
Agwu, K. K., & Okoye, I. J. (2007). The effect of music on anxiety levels of patients undergoing hysterosalpingography. Radiography, 13(2), 122-125.
Ferrer, A. J. (2007). The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment. Journal of Music Therapy, 44(3), 242-255.
Gallagher, L. M. (2011, June). The role of music therapy in palliative medicine and supportive care. In Seminars in oncology (Vol. 38, No. 3, pp. 403-406). WB Saunders.
Good, M. (1995). A comparison of the effects of jaw relaxation and music on postoperative pain. Nursing Research, 44(1),52-57
Good, M., Stanton-Hicks, M., Grass, J.A.,Anderson, G.C., Lai, H.L., Roykulcharoen,V., et al. (2001). Relaxation and music to reduce postsurgical pain. Journal of Advanced Nursing, 33(2), 208-215.
Gregory, D. (2002). Four decades of music therapy behavioral research designs: a content analysis of Journal of Music Therapy articles. Journal of Music Therapy, 39(l):56-7 l.
Hanser, S. (1985). Music therapy and stress reduction research. Journal of Music Therapy, 22(4):193-206.
Hartling, L., Shaik, M. S., Tjosvold, L., Leicht, R., Liang, Y., & Kumar, M. (2009). Music for medical indications in the neonatal period: a systematic review of randomised controlled trials. Archives of Disease in Childhood-Fetal and Neonatal Edition, 94(5), F349-F354.
Haun, M., Mainous, R. O., & Looney, S. W. (2001). Effect of music on anxiety of women awaiting breast biopsy. Behavioral Medicine, 27(3), 127-132.
Henry L.L. (1995). Music therapy: a nursing intervention for the control of pain and anxiety in the ICU. Dimensions in Critical Care Nursing, 14:295-304.
Holm, L. & Fitzmaurice, L. (2008). Emergency Department Waiting Room Stress: Can Music or Aromatherapy Improve Anxiety Scores? Pediatric Emergency Care. 24(120:836-838.
Holmes, C., Knights, A., Dean, C., Hodkinson, S., & Hopkins, V. (2006). Keep music live: music and the alleviation of apathy in dementia subjects.International Psychogeriatrics, 18(4), 623-630.
Hunter, B. C., Oliva, R., Sahler, O. J., Gaisser, D., Salipante, D. M., & Arezina, C. H. (2010). Music therapy as an adjunctive treatment in the management of stress for patients being weaned from mechanical ventilation. Journal of music therapy, 47(3), 198.
Lee, D. W., Chan, K. W., Poon, C. M., Ko, C. W., Chan, K. H., Sin, K. S., ... & Chan, A. C. (2002). Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial. Gastrointestinal endoscopy, 55(1), 33-36.
Lin. P., Lin, M., Huang, L., Hsu, H., & Lin, C. (2011). Music therapy for patients receiving spine surgery. Journal of Clinical Nursing. 20(7-8):960–8.
Loewy, J., Hallan, C., Friedman, E., & Martinez, C. (2005). Sleep/sedation in children undergoing EEG testing: a comparison of chloral hydrate and music therapy. Journal of PeriAnesthesia Nursing, 20(5), 323-331.
Mangoulia, P., & Ouzounidou, A. (2013). The role of music to promote relaxation in intensive care unit patients. Hospital Chronicles, 8(2), 78-85.
McCraty, R., Atkinson, M., Rein, G., Watkins, A.D. (1996). Music enhances the effect of positive emotional states on salivary IgA. Stress Med. 12:167-175.
McCraty, R., Barrios-Choplin, B., Atkinson, M., Tomasino, D. (1998). The effects of different types of music on mood, tension and mental clarity. Altern Ther Health Med.4:75-84.
Menegazzi, J. J., Paris, P. M., Kersteen, C. H., Flynn, B., & Trautman, D. E. (1991). A randomized, controlled trial of the use of music during laceration repair. Annals of emergency medicine, 20(4), 348-350.
Mok, E, Wong, K-Y. (2003). Effects of music on patient anxiety. AORN J. 77:396-7, 401-6, 409-10.
Mitchell, L. A., & MacDonald, R. A. (2006). An experimental investigation of the effects of preferred and relaxing music listening on pain perception. Journal of music therapy.
Newman, A., Boyd, C., Meyers, D., & Bonanno, L. (2010). Implementation of Music as an Anesthetic Adjunct During Monitored Anesthesia Care. Journal of PeriAnesthesia Nursing, 25(6): 387-391.
Negrete, B. J. (2011). The Use of Music Therapy in the Emergency Room for Pain and Anxiety Management (Doctoral dissertation).
Nilsson, U. (2008). The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN Journal. 87(4):780–807.
Nilsson, U., Rawal, N., & Unosson, M. (2003). A comparison of intra‐operative or postoperative exposure to music–a controlled trial of the effects on postoperative pain. Anaesthesia, 58(7), 699-703.
Pelletier, C. (2004). The Effect of Music on Decreasing Arousal Due to Stress: A Meta-Analysis. Journal of Music Therapy, 41(3):192-214.
Richards, T., Johnson, J., Sparks, A., & Emerson, H. (2007). The effect of music therapy on patients' perception and manifestation of pain, anxiety, and patient satisfaction. Medsurg Nursing, 16(1), 7.
Schiemann, U., Gross, M., Reuter, R. & Kellner, H. (2002). Improved procedure of colonoscopy under accompanying music therapy. European Journal of Medical Research. 7 (3): 131-4.
Sener, E. B., Koylu, N., Ustun, F. E., Kocamanoglu, S., & Ozkan, F. (2010). The effects of music, white noise and operating room noise on perioperative anxiety in patients under spinal anesthesia: 8AP3-3. European Journal of Anaesthesiology (EJA), 27(47), 133.
Short, A. E., Ahern, N., Holdgate, A., Morris, J., & Sidhu, B. (2010). Using Music to Reduce Noise Stress for Patients in the Emergency Department A Pilot Study. Music and Medicine, 2(4), 201-207.
Short, A., & Ahern, N. (2009). Evaluation of a systematic development process: Relaxing music for the emergency department. Australian Journal of Music Therapy, 20.
Smolon, D., Topp, R. & Singer, L. (2002). The effect of self-selected music during colonoscopy on anxiety, heart, rate, and blood pressure. Applied Nursing Research. 15 (3): 126-36.
Son, J.T. & Kim, SH. (2006). The effects of self-selected music on anxiety and pain during burn dressing changes. Taehan Kanho Hakhoe Chi. 36(1):159-68. Tan, X., Yowler, C.J., Super, D.M. & Fratianne, R.B. (2010
Sonke, J. (2011). Music and the Arts in Health: A perspective from the United States. Music & Arts in Action. 3(2):4-13.
Tan, X., Yowler, C. J., Super, D. M., & Fratianne, R. B. (2010). The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial. Journal of Burn Care & Research, 31(4), 590-597.
Teague, A.K., Hahna, N.D., McKimey, C.H. (2006). Group music therapy with women who have experienced intimate partner violence. Music Therapy Journal, 24:80-87.
Teckenberg-Jansson, P., Huotilainen, M., Pölkki, T., Lipsanen, J., & Järvenpää, A. L. (2011). Rapid effects of neonatal music therapy combined with kangaroo care on prematurely-born infants. Nordic Journal of Music Therapy, 20(1), 22-42.
Thaut & Davis. (1993). Identifying a preference for music contributes to a reduction in anxiety and tension.
Thaut, M., McIntosh, G. (2010). How music helps to heal the injured brain: therapeutic use crescendos thanks to advances in brain science. Dana Foundation. Retrieved on April 20, 2011 from http://www.dana.org/news/cerebrum/detail.aspx?id=26122
Voss, J. A., Good, M., Yates, B., Baun, M. M., Thompson, A., & Hertzog, M. (2004). Sedative music reduces anxiety and pain during chair rest after open-heart surgery. Pain, 112(1), 197-203.
Walworth, D. (2005). Procedural-support music therapy in the healthcare setting: A cost-effectiveness analysis. Journal of Pediatric Nursing, 20(4), 276–284.
Whipple B, Glynn NJ. (1992). Quantification of the effects of listening to music as a noninvasive method of pain control. Scholarly Inquiry for Nursing Practice. 6:43-58.
Young, T., Griffin, E., Phillips, E., & Stanley, E. (2010). Music as Distraction in a Pediatric Emergency Department. J Emerg Nurs. 36:472-2.