Create healing environment without music therapist
Sound, music can still aid medical care
If your facility doesn’t have a music therapist or thanotologist on hand, can you still add music to your repertoire of patient-focused care strategies?
Absolutely, say the nation’s top experts on the connection between sound and healing.
"Music is a perfect adjunct to medicine. While it does not replace medicine, it complements the healing process because music reduces the stress of being ill," explains Don Campbell, author of The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit (Avon, 1997).
Pat Moffitt Cook, agrees. "Music is a powerful tool in the hospital setting," says the director of the Open Ear Center in Bainbridge Island, WA, a training program that offers workshops on professional use of music in health care and wellness maintenance.
"The appropriate repertoire and application of music can induce relaxation, diminish anxiety, lower blood pressure, and facilitate better recovery," she explains. (For a more extensive list of the therapeutic benefits of music, see p. 29.)
Such benefits don’t need to be relegated to hospice or palliative care programs, points out Alice H. Cash, PhD, LCSW, one of the few clinical musicologists in the United States. Cash, who pioneered the use of chant and toning at the University of Louisville (KY) School of Medicine, is a behavior health therapist at Baptist Hospital in Louisville.
"Music can be used to ameliorate or alleviate symptoms throughout the hospital, including med-surge units, labor and delivery, [and] critical care, as well as inpatient and outpatient surgery," she says.
Music can ease delivery trauma
At Baptist, Cash encourages maternity patients to use music "in an intentional way" throughout pregnancy and childbirth. The mother and the fetus, whose hearing develops around the eighth week, can begin bonding through the music, she says.
"There is no way to know for sure, but it seems logical to me that when the fetus hears that same music during the delivery, he or she would associate it with safety and comfort. Just as music can ease the passage from this life to death, it can also make the birthing transition easier," she explains.
What kind of music should you suggest to mothers-to-be? "Experiments have shown that fetuses prefer Mozart and Vivaldi to rock," says Campbell.
Cash and Campbell also encourage couples to use music as part of preparation for natural childbirth. Campbell, who has composed music to accompany Lamaze classes, advises health care professionals to suggest music that is appropriate to each stage of labor.
For example, in the early stages, the music should be slow, relaxing and peaceful, with little change in volume or tempo, says Campbell. "In the later stages, use music with an increased tempo and steady beat to help the mother pace her stronger exertions. For example, you would select music that suggest deep, long breaths — a constant reminder to breathe deeply, push down, and relax," he says.
Immediately after the birth, the parents can listen to a song they’ve chosen beforehand. "This should be a selection that is meaningful to them — a way to mark the joyful occasion," Campbell says.
After the birth, music can continue to work its own form of medicine, points out Campbell. He cites a study of 52 premature babies with low birth weight at the Tallahassee (FL) Memorial Regional Medical Center, that shows playing 69-minute tapes of vocal music, including lullabies and children’s songs, reduced hospital stay an average of five days. "Mean weight loss also decreased about 50% for the group who listened to music."
Use music before, during, and after surgery
Cash also encourages those undergoing inpatient as well as outpatient surgery to incorporate music into their hospital stay.
In a meeting prior to the surgery, Cash explains how music can enhance the healing process and helps patients plan to make three separate tapes for pre-, intra-, and post-operative phases of the procedure.
She advises them to make the tapes a week or so in advance and begin listening to them at home. "The more you can associate that music with positive memories and activities, the more helpful it will be during surgery," she says.
She also suggests patients bring their own individual tape players and earphones, rather than a boom box. "This better masks the sound of the operation and discussion," she adds.
No later than one hour before surgery, patients should begin to listen to their pre-op tape: Music of their choice that is comforting and calming.
"This selection is entirely up to them — whatever makes them feel upbeat, secure, and positive. It may be rock, classical, country, or jazz," she says. "Oftentimes, it’s a favorite from their high school or college years that they associate with good times."
Then, during the surgery, she suggests "strictly classical" music such as Pachelbel’s Canon in D Major or Bach’s Air on a G String. "Any slow movements of the Baroque composers with an adagio or largo tempo are appropriate. You want music with a pulse of 60 to 80 beats per minute — the same as a healthy, resting heartbeat," she explains.
During the recovery period, Cash selects music with a slightly more upbeat tempo.
"I start with instrumentals that are simply textured, such as a harp or flute, then after two or three selections, I begin to add more instruments, perhaps, and to incorporate pieces with words, something to bring them back," she says.
The brain can process music even when the patient is unconscious, adds Cash, citing her most dramatic case: A man in a coma for six weeks. "Every day, while the ICU nurse bathed him and changed the linen, she whistled and hummed and sang," she says. Then one day, the man suddenly woke up. "He came back a few weeks later to thank the singing nurse.’ When we replied that our nurses don’t sing, he said, One of them does. When I heard her, I knew I was still alive. Her voice brought me back to life.’"
Silence is also beautiful
While some experts in sound and healing acknowledge that stimulation in an ICU unit is important, others feel too much of it may actually be detrimental to patients’ health.
"Polluted with noise from beepers, ventilators, conversation, and television, the ICU can reach 80 decibels — the equivalent of a loud subway ride or blaring rock music," says Richard P. Millman, MD, FCCP, professor of medicine in the division of Pulmonary, Sleep and Critical Care Medicine at Brown University School of Medicine, and director of the sleep disorder clinic at Life Span Hospital. The Environmental Protection Agency standard for noise levels at inpatient facilities is 45 decibels in the daytime and 35 decibels at night.
Such noise pollution has several negative consequences, explains Millman. "For the patients on ventilators, sleep deprivation can make weaning more difficult because it affects respiratory muscle function. It also causes symptoms of ICU psychosis,’" he says.
Critical care nurses also suffer from working in a loud environment.
"Noise has been implicated in contributing to nurse burnout," he says.
Millman advocates setting beepers to vibrate mode, speaking in low tones, and most of all, turning off the television.
"When it is blasting, staff and visitors have to speak above it, so noise levels from conversation escalate," he says. He recommends individual television earphones for patients. "Yet, we heard some of the nurses insist, I want to watch my show.’ The television should be there to stimulate the patients, not the staff."
Once the overall noise level is lowered, then music can be added to create a healing environment. For example, at St. Agnes Hospital in Baltimore, classical music is played for patients in critical care units. "Half an hour of music produces the same effect as 10 milligrams of Valium," reports Raymond Barh, MD, director of the coronary care unit.
Sources
• Alice H. Cash, Baptist Hospital East, Center for Behavior Health, 4000 Kresege Way, Louisville, KY 40207. Telephone: (502) 896-7105.
• Don Campbell, P.O. Box 4179, Boulder, CO 80306. Telephone: (314) 531-4756.
• Open Ear Center, 6717 N.E. Marshall Road, Bainbridge Island, WA 98130. Telephone: (206) 842-5560.
Ten ways music can affect people
1. Music masks unpleasant sounds and feelings.
2. Music can slow down and equalize brain waves.
3. Music affects respiration.
4. Music affects the heartbeat, pulse rate, and blood pressure.
5. Music reduces muscle tension and improves body movement.
6. Music affects body temperature.
7. Music can increase endorphin levels.
8. Music can regulate stress-related hormones.
9. Music and sounds can boost the immune function.
10. Music changes our perception of space.
Source: Don Campbell, The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit. Avon, 1997.
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