Live music for individual patients-THERAPEUTIC MUSICIAN

Answers to therapeutic music FAQs

Here are answers to some of the questions I am asked about playing therapeutic music at the bedside.

What is the return on investment (ROI) for the healthcare facility to hire therapeutic musicians?

There are many benefits to having therapeutic musicians on staff.

• Experiencing a therapeutic music session can increase patient satisfaction, which contributes to higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.
• Providing therapeutic music shows compliance with EP2 in the The Joint Commission Pain Management Standards➚. Providing therapeutic music to those dealing with opioid addiction shows compliance with EP4.
• Faster healing times can result in higher patient turnover rates…
• …while staff exposure to therapeutic music sessions can reduce staff turnover.
• Decreased anxiety in patients can result in a less harried, more efficient staff.
• Adding a therapeutic music program to your facility’s offerings can result in increased publicity.
• Conducting research on the benefits of live, acoustic music at the bedside can result in grant money and recognition.

What are your rates?

My rates are comparable to a Registered Nurse or massage therapist.

I am currently employed at St. Barnabas Medical Center in Livingston, NJ, through the Pastoral Care Department. This means my services are free to patients and their caregivers at that hospital.

For private sessions, rates can be affected by travel time and other factors. Please contact me for rates that are applicable to your specific situation.

Is this covered by insurance/Medicare/Medicaid?

No.

Music practitioners today find themselves in a similar place that acupuncturists and massage therapists were in a few years ago. As the benefits of live, therapeutic music become more and more documented and publicized, the chance that we will be covered by insurance increases. 

Organizations like the Music for Healing and Transition Program➚ (MHTP) and the Sound and Music Alliance➚ continue to conduct and fund research in order to promote the benefits of therapeutic music. I serve on the MHTP Research Committee.

Why don’t you just volunteer?

Because it is skilled healthcare work.

Although nurses, doctors, psychologists, and other healthcare professionals might volunteer some of their time for some situations, they are professionals. Even with today’s insurance debacle, no one is arguing that healthcare staff should not be paid; they are arguing about where the money should come from.

If I were choosing music for my personal satisfaction, without regard for the patient, then I would not be asking for pay. However, a Certified Music Practitioner® is trained to apply our music skills to a healthcare environment, working regularly alongside the healthcare staff, focusing on the needs of patient, and altering the music to fit those needs in the moment. This is very different from entertaining.

Can any musician play at the patient’s bedside (without training in therapeutic music)?

You decide.

I realize that when a degree or certificate is available, people who have that credential often argue that no one can do their job without it. 

If you are on the staff of a healthcare facility, I would ask if you feel comfortable having an unskilled, uninsured musician address individual patients?

If you are a musician, I would ask if you feel capable of walking into the room of someone who is sick or dying, who could be in critical condition, who might have just come out of heart surgery, who might not be able to speak with you about what they want, who is in their most vulnerable state—could you play for them, one on one, to foster a healing environment?

Are you taking jobs away from music therapists?

No.

The best analogy is to think of music therapists like physical therapists and therapeutic musicians like massage therapists. Then ask: Do massage therapists take jobs away from physical therapists?

Music practitioners perform a task that some music therapists are beginning to include in their therapy toolbox, but the focus of music therapy is therapy. Therapeutic musicians do NOT do therapy.

Does therapeutic music work?

Yes.

The results of playing therapeutic music for an individual patient can be observed in the heart rate, pulse rate, and blood pressure in the monitors, as well as in the physical relaxation of their face and body. Effects on pain tolerance, stress reduction, and the immune system are well documented.  Read some of the research that supports healing music.

Does it work for all patients, all of the time? No therapy—pharmacological, physical, cognitive—works for all patients, all of the time.

Do you play specific songs for specific health conditions?

Not quite.

This is a big reason that therapeutic musicians receive training. If we could state which song always works for which illness, then this work would be much simpler!

There are general rules that Certified Music Practitioners are trained to follow with regards to what types of music work or don’t work for certain conditions. For example, we’re not going to play music with an irregular rhythm for a patient with a heart condition. We’re not going to play non-stop notes for a patient with COPD.

But the rule first and foremost is to play what works for the patient that you are with. Even if you have played for that patient before, what worked then might not work the same way today.

The nebulous nature of what works and what doesn’t necessitates training in observation and the skillful alteration of musical elements. 

Do you take requests?

I do not ask for requests.

Taking requests is more like entertaining than providing a therapeutic session. Asking a patient for requests can mean that you want them to pay attention to you, which removes their permission to relax. It also puts the onus on the patient to figure out what would be healing for them. 

How can you know what the patient wants to hear without asking them?

By observing their reactions.

This question is especially important for patients who are not able to speak. While I am playing, I simultaneously watch the patient. Does their expression change? Their body position? Their breathing? Blood pressure, heart rate, pulse ox, or anything else on the monitors?

If the music is having no effect or a negative effect, I change it. Watch me play some examples of imagined patient scenarios.

Do you play hymns?

Not unless the patient asks me to.

The Music for Healing and Transition Program is not affiliated with any religious association and expressly forbids proselytizing. I do not go into a patient’s room with any religious intentions. Read more about ethics for music practitioners.

If a patient requests a hymn, and if I know it, I play it. (The request must come from the patient rather than a visitor.) If I don’t know it, I say so, and I judge what I have  in my repertoire that can serve their needs.

What do you do with your harp if there is an emergency with the patient?

I get out of the way fast.

My harp weighs nine pounds, and I usually play standing up. If there is an emergency, I can quickly move myself and the harp out of the way. Going from room to room, the harp, stool, stand, and sheet music are all in a cart that can be easily pushed aside by healthcare staff should the need arise.

Ready to contact me? Or, read more about live, therapeutic music at the bedside.

Live music for individual patients

Today’s typical healthcare facilities are busy, loud, unfamiliar places where patients have little control. Everyone who attends the patient wants something from them—doctors ask questions, nurses poke and prod, and visitors want to be reassured.

My goal is to make it easier for people to heal in a hospital.

What does a therapeutic musician do?

Therapeutic musicians play live, acoustic music to patients one-on-one at their bedside to create an environment that can be conducive to healing. We chose the music according to the patient’s needs in the moment. As the patient’s needs change, we change the music accordingly.

We work collaboratively with the healthcare facility staff or hospice team, discussing the patient’s condition within HIPAA requirements, and charting the patient’s reactions and results.

Therapeutic musicians are trained to focus on the individual patient we’re serving. We ask nothing from the patient except their permission. We use sound to create a space for the patient where they can let healing occur.

Why provide music at the bedside?

• To boost the immune system
• To accelerate surgical recovery
• To alleviate anxiety and stress
• To stabilize heart rate and reduce blood pressure
• To reduce the need for anesthesia and pain medication
• To promote healing or assist in the life/death transition

Read some of the research that supports healing music.

Why live music?

One of the biggest differences between receiving recorded music versus live music is that a live musician can alter the music to fit the patient’s needs instantly, changing not only what song they are playing but how they are playing it. Studies suggest that the patient's music preference plays an important factor in influencing their healing response to the music. 

Another advantage comes from using an acoustic instrument. The full spectrum of sound from my harp reaches the patient without being compressed or filtered by the recording process or speakers. The patient can feel the resonance of the music in a way that is not possible with tapes, CDs, or music downloads. Arnon et al. 2006 (PDF➚) shows longer-lasting beneficial effects from live music than from recordings.

How I can help

As a Certified Music Practitioner, I am trained to provide live, therapeutic music as a service to patients who are ill, in order to foster a healing environment. For patients who are dying, I am trained to help with the life/death transition.

I serve individual patients, one-on-one at their bedside in the hospital, hospice, or nursing home. I work near Jersey City and New York City. 2. WHO CAN BENEFIT

Benefits for patients, visitors, & staff

Therapeutic music at the bedside benefits all types of patients as well as the people who support them.

Benefits to patients in all conditions

Live, acoustic music can benefit any patient who is able to hear or feel the vibration of sound. Unlike music therapy, a patient receiving therapeutic music does not play or sing along. 

This means that patients in a coma, women in labor, infants and preemies, the actively dying, patients with severe burns, and other patients for whom it is painful or impossible to move can all benefit from music at the bedside.

Some studies suggest that patients can also benefit from receiving music at the bedside while undergoing a procedure. Therapeutic music can distract from painful dressing changes. It can relax muscles and blood vessels to help with inserting an IV or passing a Foley catheter. Additional benefits:

• Less stress
• Less anxiety
• Lower blood pressure
• Higher pain tolerance
• A boost to the immune system
• More sleep
• Better sleep
• Distraction from hospital noise and activity in general

Read some of the research that supports healing music.

Benefits to visitors and caregivers

Patients can receive a therapeutic music session while visitors are present. The patient’s friends and family might also be exhausted, anxious, and stressed. Even though the focus of the session is on the patient, the music can still help relax others who hear it.

There can be a compounding effect as well. The visitors relax more from seeing the patient relax, and the patient relaxes even more from seeing their visitors relax.

Friends and family might be present at the bedside of someone who is dying. Seeing the effect of the music on their loved one helps to create a healing environment for those left behind.

Benefits to healthcare staff

Although the full benefit of live music at the bedside goes to the patient who is the focus of the service, sound travels. Staff who are attending the patient or the patient’s roommate, or other staff who are nearby, can feel some of the music’s soothing effects.

The staff also benefit from the results that the patient experiences. When a patient who was acting out calms down, when a patient who was in great pain finally falls asleep, then the staff have less work to do and feel less stress themselves.

3.

Research supports therapeutic music

One of the reasons I chose to learn how to provide live harp music for patients is that beneficial results can be seen in the monitors instantly. At the bedside and the nurse’s station, we can witness the change in heart rate, respiration, blood pressure, and pulse oximetry as I'm playing, and there can be no doubt that the music is having a soothing effect…

…and we can also see if the music is not making things better. I request permission of all responsive patients before I play for them, and a responsive patient can ask me to stop at any time. If a patient cannot respond, then I watch the monitors closely to make sure the music or a particular tune is not negatively stimulating.

What can music do?

The studies cited below show that providing patients with soothing music can:

• Reduce anxiety in general and before surgery
• Influence heart rate and respiration
• Reduce blood pressure
• Lessen the perception and increase the tolerance of pain
• Boost the immune system
• Decrease stress hormone levels
• Distract from negative situations
• Aid sleep

Selected research on therapeutic music

Some studies use the term "music therapy" to refer to a patient passively listening to music. I have only cited studies that use “music therapy” in this passive sense. Studies about real music therapy do not reflect what I do as a therapeutic musician. Read more about the difference between music therapy and therapeutic music.

Where noted, some links go to the full article. The rest of are to the abstract. All links open in a new window.

Studies with live music

A controlled study showing the benefits of live music over recorded music. It describes the effect of music on reducing heart rate and enhancing sleep. Arnon S, Shapsa A, Forman L, Regev R, Bauer S, Litmanovitz I, and Dolfin T. Live music is beneficial to preterm infants in the neonatal intensive care unit environment (link to full study PDF➚). Birth. 2006;33(2):131-136.

An exploratory study about the effect of live music on helping with pain, reducing anxiety, and decreasing muscle tension. Sand-Jecklin K, Emerson H. The impact of a live therapeutic music intervention on patients’ experience of pain, anxiety, and muscle tension➚. Holist Nurs Pract. 2010;24(1):7-15.

General therapeutic effects of music

A review of studies on the wide-ranging benefits of therapeutic music. It describes the effect of music on reducing anxiety, distracting from negative situations and procedures, and helping with pain. They discuss the importance of patient preference in choice of music. Kemper KJ, Danhauer SC. Music as therapy (link to full study➚). South Med J. 2005;98(3):282-8.

A systematic review of the effect of music on reducing pain. Engwall M, Duppils GS. Music as a nursing intervention for postoperative pain: a systematic review➚. J Perianesth Nurs. 2009;24(6):370-383.

A report on the beneficial effects of music, such as reducing stress, increasing relaxation, controlling pain, reducing anxiety, and increasing heart rate variability. Trappe HJ. [Music and health--what kind of music is helpful for whom? What music not?]➚. Dtsch Med Wochenschr. 2009;134(51-52):2601-2606.

A meta-analysis about the effect of music on increasing sleep quality. de Niet G, Tiemens B, Lendemeijer B, Hutschemaekers G. Music-assisted relaxation to improve sleep quality: meta-analysis➚. J Adv Nurs. 2009;65(7):1356-64.

How preferred music affects relaxation and pain tolerance

A randomized clinical trial showing the effect of music on oxytocin levels (increased relaxation). Nilsson U. Soothing music can increase oxytocin levels during bed rest after open-heart surgery: a randomised control trial➚. J Clin Nurs. 2009;18(15):2153-2161.

A randomized clinical trial showing the effect of music to change the neuro-hormonal and immune stress response, especially when the patient’s music preference is taken into account. Leardi S, Pietroletti R, Angeloni G, Necozione S, Ranalletta G, Del Gusto B. Randomized clinical trial examining the effect of music therapy in stress response to day surgery➚. Br J Surg.2007;94(8):943-947.

A quasi-experimental pre/post-test study showing the effect on music on controlling pain. It discusses the importance of patient preference in choice of music. Good M, Ahn S. Korean and American music reduces pain in Korean women after gynecologic surgery➚. Pain Manag Nurs. 2008;9(3):96-103. Erratum in: Pain Manag Nurs.2008;9(4):142.

A study on how different types of music cause different reactions, enforcing the need to respect the patient’s music preference. McCraty R, Barrios-Choplin B, Atkinson M, Tomasino D. The effects of different types of music on mood, tension, and mental clarity (link to full study PDF➚). Altern Ther Health Med. 1998;4(1):75-84.

4.

Music practitioners are not therapists

The media and some scientific literature often refer to any application of music in a healthcare setting as “music therapy.” This confuses the therapy that is done by board-certified music therapists.

Therapeutic music is a service; music therapy is a treatment program

A music therapist uses “music interventions to accomplish individualized goals within a therapeutic relationship” (music therapy defined➚). On most of the music therapy websites, you will see a photograph of the music therapist working with a patient who is playing an instrument.

A Certified Music Practitioner provides live, therapeutic music at the bedside and refrains from soliciting the patient’s participation. 

Think of the difference between a physical therapist and a masseuse. Both have training, and both provide benefits, but the degree and the duration of interaction are different.

Certified Music Practitioner (CMP)®

1. Has graduated from the Music for Healing and Transition Program➚
2. Meets the patient in this moment, creating a healing environment that addresses the condition or changing conditions that the patient is experiencing right now
3. Provides music for the patient to receive passively (no interaction)
4. Often sees a patient just this one time

Board-Certified Music Therapist (MT-BC)

1. Has completed a bachelor’s or master’s degree in Music Therapy
2. Creates a therapeutic goal to be realized over several planned sessions of therapy
3. Actively engages the patient in music by having the patient play an instrument, write a song, or perform other musical activities
4. Usually sees patients regularly until the therapeutic goal is attained

5.

Ethics & scope for therapeutic musicians

The Music for Healing and Transition Program➚ defines the scope of practice as well as the code of ethics and conduct for Certified Music Practitioners. These documents outline our role in the healthcare team and our behavior with respect to the patient and their families. These documents also help to define how therapeutic music is different from music therapy.

Excerpts from the MHTP scope of practice

These definitions are quoted directly from the Scope of Practice of the Certified Music Practitioner (my emphasis). You can read the entire document on MHTP’s site here: complete MHTP scope of practice➚

With regards to patient interaction:

• A Certified Music Practitioner (CMP) approaches the patient from the stance of being of service, rather than as a performer.
• A CMP refrains from utilizing music or the musical instrument in a manner that solicits patient participation.
• A CMP uses only simple statements for self-introduction, patient orientation to the therapeutic music session, and for obtaining the patient’s permission when initiating the session and during the session.
• A CMP refers patient needs to other members of the healthcare team when the needs are not within the Scope of Practice of a therapeutic musician.

With regards to musical proficiency:

• A CMP can extend and adapt musical pieces to differing rhythm, meter, and tempo as required by the patient’s condition in-the-moment.
• A CMP understands and uses silence as an integral part of each music offering.

With regards to ethical and professional behavior:

• A CMP obtains referrals following appropriate protocols.
• A CMP conducts information-sharing sessions (in-services, etc.) providing accurate and appropriate information about, and within the scope of, therapeutic music, respecting the intellectual property rights of MHTP.
• A CMP regularly practices a form of self care which fosters self-development and self-understanding, and provides a method to relieve the emotional and physical stresses of working in a therapeutic environment.

Excerpts from the MHTP code of ethics and conduct

These definitions are quoted directly from the the MHTP Code of Ethics and Conduct (my emphasis). You can read the entire code here: complete MHTP Code of Ethics and Conduct➚

• I will perform my work as a Certified Music Practitioner with integrity, always keeping the interest of the patient I am serving as my priority.
• I will respect the patient’s rights and dignity, providing therapeutic music based upon each patient’s unique needs and with respect for individual patient differences.
• I will work harmoniously with nurses, physicians, and other members of the patient’s healthcare team and staff in those facilities where I serve.
• I will hold all information shared during a therapeutic music session as confidential and uphold all HIPAA requirements.
• I will refrain from incorporating other healing modalities into my therapeutic music sessions unless I have the qualifications to do so and unless I have the patient’s and/or the family’s/caregiver’s permission.
• I will refrain from proselytizing my religions beliefs through choice of music or speech during a therapeutic music session.

6.

What occurs in a typical therapeutic music session

I can provide therapeutic music at the bedside in hospitals, hospice facilities, or nursing homes, as well as a patient’s home. 

Here is a description of a typical session in a hospital for a patient who is not actively dying.

Obtaining referrals

I talk to the charge nurse on the floor I’ve been assigned to. I ask who would benefit from some soothing music today. I’ve already made sure that I arrive on the floor at a time that is convenient for the staff.

I ask for anything the nurses can tell me about the referred patients and their conditions, within HIPAA requirements. A good example of information that is appropriate for me to know is whether or not the patient has a heart condition, which would call for music with a steady rhythm. Another example is if the patient is hard of hearing, which would necessitate louder playing than usual.

If there are too many referrals, I discuss why each person is being referred so that I can prioritize.

Requesting the patient’s permission

My harp is already tuned and ready to go. I take it to the first referral and knock softly in case they are asleep. I introduce myself and let them know that I have a harp with me. I explain that this is a service provided by the hospital. Would they like some soothing music today?

I tell them that it is okay for them to close their eyes or fall asleep. They can ask me to stop at any time. This helps the patient understand that this is not a performance, allowing them to receive this as healing music. They have permission to let go rather than “being polite” and staying attentive.

If they have visitors, I can play while they’re here, or I can come back. (Sometimes visitors are eager to have something else to focus on besides their loved one’s hospital stay.)

If the patient is non-responsive, I introduce myself and request permission in the same way. I explain that I will watch them while I play for any sign that they would like me to change the music or stop. If a non-responsive patient has a visitor, I request permission from that visitor as well.

About two thirds of the patients I request permission from agree to the service. Therapeutic music is one of the few things that patients have a choice about in the hospital. It can be empowering for them to exert some control over who is in their room. When that occurs, I thank them and move on to the next referral.

Setting up at the bedside

After I receive the patient’s permission, I bring my harp into the room. If their roommate is awake, I ask them if it is okay for me to play, or if I should close their curtain. I also have my own small stool, so I don’t need to rearrange any of the patient’s furniture.

I position my harp where I have a good view of the patient, and I assess their condition. A session is completely personal to the patient, focused on what they need right now. 

Their state in this moment suggests to me whether I should play music they recognize or something unfamiliar, at a quick tempo or slowly, with rich harmonies or sparse accompaniment. Should the song be happy, sad, sleepy, invigorating, calming, tender, uplifting, grounding? Or should I not play any song, but just let simple notes ring out and fade away? Listen to some examples.

Creating a healing environment with the music

As I play, I continue to observe the patient’s condition, using the monitor if available, or otherwise watching their breathing, their expression, and their body position. How I play at the beginning of the session does not determine how I will play for the rest of it. I am constantly reevaluating the patient’s needs.

A lot of the research on therapeutic music indicates that it is important to play a type of music that the patient prefers. One of the benefits of having a trained, live musician is that I can determine which music gives the patient the best results. I watch their reactions so that I can play more of what is beneficial or stop playing something that doesn’t work.

When I started playing for patients, I was surprised at how rarely they ask what type of music I’m going to play. Since this is not a performance, I don’t ask them what they want to hear. My training as a Certified Music Practitioner is effective enough that I can choose the right music without conferring with them.

Completing and charting the session

Since different patients need different things from the music, the end result of a session is not always the same. If the patient needed to fall asleep, then, ideally, the session ends when they fall asleep. If the patient needed to calm their anxiety, then, ideally, the session ends when they relax. If the patient was in an unstable condition, then, ideally, the session ends when they stabilize.

A typical session lasts for 20 or 30 minutes.

When it is over, I thank the patient for allowing this service (silently if they are asleep), and I thank any visitors who were there. I exit with my stool and my harp.

I go to a logging station to record the session in the patient’s chart, including their state before and after and any other reactions. After that, I am on to the next referral.

LINK: https://www.soothingharp.com/an-example-therapeutic-music-session