By: Group Ripple: Ashley Bridges, Rita Daniels, Holly Ehrke, and Mallory Olson

1. Does music therapy influence health outcomes in patients who have chronic health conditions? Please click on sound icon of each slide to hear narration By: Group Ripple: Ashley Bridges, Rita Daniels, Holly Ehrke, and Mallory Olson

2. Why Music Therapy? • “It may sound cheesy, but for me, music reaches into the soul. I think most people can relate to it, whether its the words of a song, playing music themselves, or just listening to it openly. It can change a mood, which might just change your day.” – Ashley Bridges • “Music lets you relax, touches your heart, lifts your mood, helps you relate.” –Holly Ehrke • “Music can be used to change an environment, it can be used as distraction, and help relieve tension and pain.” –Mallory Olson • “Music takes a person outside of themselves and transports them to another place.” – Rita Daniels

3. Introduction to Music Therapy: Practice Environment • Music began it’s use as a healing instrument following World War II when the veterans hospitals were visited by community musicians who played to veterans suffering from both physical and emotional trauma (AMTA, 2011a).

4. Introduction to Music Therapy: Practice Environment • In the 1800s, we would first see a music therapy intervention recorded as well as medical dissertations referencing music’s therapeutic value (AMTA, 2011a). • In the 1940s, music therapy became an organized clinical profession and the first academic program in music therapy was created (AMTA, 2011a). • “Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program” (AMTA, 2011b, para. 1).

5. Introduction to Music Therapy: Practice Environment • “Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people’s motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings” (AMTA, 2011b, para. 2).

6. Introduction to Music Therapy: Practice Environment • Michael Mayne, Dean Emeritus of Westminster, gave a lecture titled Music, Spirituality, and Healing at the 10th World Congress of Music Therapy. According to Dorit Amir, Mayne “talked about the connection between spirituality, music, sickness, suffering, and being human. He perceives music as religion and believes that music defines us, human beings. It brings chaos, harmony to the soul and healing to spiritual pain. Michael Mayne defined spirituality as a sense of the beyond that gives meaning and value to our lives. He urges us to open ourselves to the hidden qualities in music and words, to go to the beyond, to discover the hidden depth of the human spirit” (Amir, 2002, para. 7).

7. Articles selected were found using: Ferris State University Library Internet Searches Databases: PubMed CINAHL “The most relevant nursing online database is CINAHL, which contains citations of nursing literature, published commonly starting in the 1980s, but some versions may have information back to the 1930s” (Burns & Grove, 2011, p. 211). Method of Research

8. How the research was gathered All articles were retrieved from nursing and health care journals. All the articles were current, with the least current article from 2008. Studies included: Mixed-methods study (small randomized pilot & qualitative interview) Exploratory study with grounded theory Cluster analysis study Theory synthesis using database review Quantitative & Qualitative peer-review studies.

9. Nursing Implications • Promising objectives for physical rehabilitation, Alzheimer’s disease, and psychoneuroimmunology • Health promotion and rehabilitation programs will assist communities in becoming healthier • Involvement of pediatric cancer patients in Creative Arts, such as music therapy, to assisting in the healing of cancer treatments • The directed use of music and music therapy is highly effective in developing coping strategies, including understanding and expressing feelings of anxiety and helplessness, supporting feelings of self-confidence and security, and providing a safe or neutral environment for relaxation (Degmecic, Pozgain, Filakovic, 2005, p. 298).

10. Nursing Implications Continued Why use music therapy? • Low cost, ease of implementation, minimal-to-low risk of harmful side effects, and potential to improve patient satisfaction • Improved health outcomes for patients with chronic illnesses • Improved health outcomes with the initiation of music therapy to promote physical activity in various community, assisted living, nursing homes and acute care settings

11. Our own Implications for Practice Holly Ehrke: If the timing & atmosphere is right for the family of a deceased patient, I will play soft, back-ground music as the family congregates to say their “good-byes” in the Emergency Room. In the School-Based Health Center, I play “hip-hop”, fast-moving music, as in the Cupid Shuffle, to educate students on obesity & nutrition. Ashley Bridges: Music therapy is a challenge to implement in ER nursing because of the short amount of time available with patients. Encouraging patients to use the relaxation channel or use their MP3 players helps to reduce anxiety regarding unfamiliar procedures and waiting times for results. Mallory Olson: I use music to help calm patient’s struggling with pain or anxiety. Our hospital has a channel on the television that displays nature pictures while playing calming music and this seems to be helpful to many patients. Rita Daniels: I would encourage music therapy to my home health care-based population as an excellent adjunct for exercise and reminiscence.

12. Theoretical Perspectives Psychological relationship between music and pain Cognitive coping strategies Spinal Mechanisms involved in modulation of pain aka “Gate control theory” Endorphins as natural opiates Research Limitations Small sample sizes Selective populations Studies often theoretical in nature Controlled studies only recently

13. Who benefits from music therapy for chronic health conditions? Patients with chronic health conditions Developmental and learning disabilities Alzheimer’s patients Substance abuse problems Brain injuries Acute and chronic pain Laboring mothers Cancer patients Patients with anxiety

14. Who benefits from music therapy for chronic health conditions? During a cluster-analysis study, patients who were more likely to benefit from the intervention of music therapy were older, female patients with less education (Chan, M.F., Chung, Y.F.L., Chung, S.W.A., & Lee, O.K., 2008). In a mixed method study, including a randomized pilot and a descriptive study, future nursing implementation of creative arts may aid in the therapeutic healing process of pediatric cancer patients (Madden, J.R., Mowry, P., Gao, D., Cullen, P.M., & Foreman, N.K., 2010). “Engagement with creative activities has the potential to contribute toward reduction of stress and depression and can serve as a vehicle for alleviating the burden of chronic disease” (p. 254). This evidence was found through research analysis of both qualitative and quantitative, peer-reviewed studies already performed related to art and music therapy.(Stuckey, H. L., & Nobel, J., 2010).

15. Benefits of Music Therapy Psychological Benefits • Connect and express feelings • Promotes interaction between loved ones • Helps restore emotional balance • Promotes relaxation • Decreases pain sensation • Reduces anxiety • Increases sense of control Physical Benefits • Lowers respiratory and heart rates • Increases peripheral temperature • Decreases cortisol levels • Decreases myocardial oxygen demand • Calms neural activity in brain • May help restore effective immune system functioning via actions of amygdala and hypothalamus

16. Considerations • Patients should choose when possible • Assess familiar versus non-familiar preferences • Trial, monitor responses, and assess volume preferences • Chose appropriate to patient’s attention span and energy level • Observe for adverse effects

17. Conclusions How does music therapy work? Promotes activity which helps to alleviate pain, fatigues and troubles Modifies a person’s internal and external environment to improve health outcomes What benefits does music therapy provide? Improves health outcomes Promotes healthy behaviors in spite of illness Increases self-awareness of well-being Promotes positive effects for the mind and positive influences on health Practice Areas that may benefit from music therapy Long term hospital stays, patients with cancer, terminally ill, patients undergoing laceration repair in the emergency department, patients undergoing surgery, patients undergoing colonoscopy, patients with Alzheimer’s disease

18. References American Music Therapy Association (AMTA). (2011a). History of music therapy. Retrieved from http://www.musictherapy.org/about/history/ Batt-Rawden, K., Tellnes, G. (2010). How music may promote healthy behavior. Journal of Public Health, 39(2), 113-120. Retrieved from: http://sjp.sagepub.com/content/39/2/113. doi: 10.1177/1400494810494555 Burns, N., & Grove, S. (2011). Understanding Nursing Research. Maryland Heights, MD: Elsevier Saunders.

19. References Chan, M.F., Chung, Y.F.L., Chung, S.W.A., Lee, O.K. (2008). Investigating the physiological response of patients listing to music in the intensive care unit. Journal of Clinical Nursing, 18, 1250-1257. doi: 10.111/j.1365-2702.2008.02491.x Degmecic, D., Pozgain, I., Filakovic, P. (2005). Music as therapy. International Review of the Aesthetics and Sociology of Music. 36(2), 287300. Retrieved from: http://www.jstor.org/stable/30032173 Richards, T., Johnson, J., Sparks, A., Emerson, H. (2007). The effects of music therapy on patient’s perception and manifestation of pain, anxiety, and patient satisfaction. Medsurg Nursing, 16(1), 7-14.

20. References Madden, J.R., Mowry, P., Gao, D, Cullen, P.M., Foreman, N.K. (2010). Creative arts therapy improves the quality of life for pediatric brain tumor patients receiving outpatient chemotherapy. Journal of Pediatric Oncology Nursing, 27(3), 144-145. Retrieved from: http://jopon.sage.com. doi: 10.1177/104 Murrdock, C.J., Higgins, P.A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65(10. 2249-2257. doi: 10.1111/j.1365-2648.2009.05108x Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2), p. 254-263.