Implementing music therapy on an adolescent inpatient unit: a mixed-methods evaluation of acceptability, experience of participation and perceived impact

Development and integration of a music therapy program in the neurologic inpatient setting: a qualitative study

PURPOSE

Explore facilitators and barriers to development and integration of an inpatient music therapy (MT) program from the perspective of the patient, family member, and health care professional.

MATERIALS AND METHODS

This qualitative study recruited patients on acute neurosciences/neurorehabilitation units having participated in the hospital MT program, their family, and members of their health care team. Semi-structured individual interviews and focus groups were conducted with 35 participants (14 patients, 5 family members, 16 health care professionals). Interviews/focus groups were audio recorded and transcribed verbatim. Data were coded in duplicate and a codebook was developed through an iterative process.

RESULTS

Four dominant themes emerged from the data: (1) facilitators of program operations; (2) barriers to program establishment; (3) perceived positive impact on patient outcomes; and (4) opportunity for improvement. Facilitator sub-themes included a love for music that encouraged participation, broad appeal of MT, and support of the health care team.

CONCLUSIONS

Patients, health care professionals, and family members accepted MT as a treatment modality. While there is growing evidence for MT in neurorehabilitation, practical challenges remain in developing inpatient MT services, including funding, and optimal integration of music therapists into existing care teams.

Empowerment in Adolescent Patients with a Disability/Chronic Condition: A Scoping Review

BACKGROUND/OBJECTIVES

Empowerment has been associated with several positive outcomes in healthcare; however, there is limited insight on empowerment levels within the adolescent population of those with a chronic condition/disability. The aim of this scoping review was to identify gaps in the existing literature on empowerment levels within this population.

METHODS

Five databases (MEDLINE [Ovid], EMBASE [Ovid], PsycINFO [Ebsco], CINHAL [Ebsco] and Web of Science [UBC]) and grey literature were searched.

RESULTS

A total of 67 studies were included and used for data extraction including descriptive numerical analysis followed by a narrative review. Extracted data were divided into demographic characteristics (e.g., ethnicity/ancestry), type of disability/condition (e.g., type 1 diabetes), interventions used to increase empowerment or empowerment-adjacent elements, quantitative and qualitative tools used to measure empowerment (e.g., questionnaires and/or interviews), domains/outcomes associated with empowerment (e.g., self-control), and review articles. Several interventions were shown to have positive effects on empowerment levels in adolescents with a chronic condition/disability.

CONCLUSIONS

Gaps were identified in the consideration of ethnicity/ancestry and socioeconomic status, demonstrating a need for future research in this space to focus on the intersection of disability, ethnicity/ancestry, and socio-economic status and the implementation of interventions promoting empowerment.

Perceptions about children and adolescents' mental health crisis intervention: a qualitative systematic review

This review aimed to identify and synthesize the perceptions of mental healthcare professionals, family members, and users about mental health crisis interventions for children and adolescents at hospitals and community mental health services. A qualitative systematic review was conducted following the Joanna Briggs Institution guidelines. The search was performed in 15 databases, with no temporal delimitation, and included studies in Portuguese, English, and Spanish. All works were assessed regarding methodological quality, credibility, and dependability according to the ConQual score and the recommendations were assessed following the Joanna Briggs Institution guidelines. In total, two independent reviewers screened and assessed the studies, extracted their data, developed categories, and conducted the thematic synthesis. A total of 13 studies met the inclusion and exclusion criteria. From these, five syntheses were developed: importance of relationships; importance of procedures during treatment; positive emotional responses to treatment; negative emotional responses to treatment; and issues with health professionals and health services. All five syntheses presented high dependability; two syntheses presented high credibility; and three presented moderate credibility. Mental healthcare professionals, family members and users had convergent perceptions about crisis intervention provided at healthcare services. Understanding their perceptions to improve care and the user experience in this vulnerable situation is crucial.

Music Matters - A Qualitative Evaluation of a Nurse-Led, Group-Based Music Program Complementary to Early Intervention for First-Episode Psychosis

First-episode psychosis is a significant mental health condition that can have a profound and lasting effect on an individual's functional abilities and overall quality of life. While music therapy has shown promise in improving these areas, there is a lack of research exploring the impact of music groups led by mental health professionals without formal music therapy training in the context of early intervention in psychosis. This study aimed to conduct a qualitative evaluation of a once-weekly, 12-week, nurse-led music group, offered as an adjunct to early intervention in young people with first-episode psychosis. The specific objectives were to explore social interaction and experiences of participants and instructors in relation to the music group and provide focus points for implementation in clinical practice. The study utilized Interpretive Description, collecting data through participant observation (6 sessions × 1.5 hrs; 9 hrs in total), key informant interviews (n = 1), and group (n = 4) and email-based (n = 2) interviews. The data was transcribed, thematized, and analyzed using NVivo12 and Interpretive Description inductive analysis resulting in three main themes: Practicalities of the music group, Restored identity, and Music as medicine reflecting the potential of the music group to contribute to a sense of non-patient identity, decreasing symptoms related to mental illness, foster social relationships and a feeling of belonging to a musical community. This study highligts how participation in music groups can be a possible promoter of recovery. However, sustainability appears contingent on the skills and resources of the facilitator (i.e., nurse). Suggestions for a program theory and clinical implications are presented and discussed.

The perception of healthcare professionals, through their own personal experiences, of the use of music therapy in hospitalised children and adolescents

BACKGROUND

Music therapy is an emerging and useful methodology for improving patient environments within healthcare fields. However, although it has been shown that music therapy interventions with hospitalised children and adolescents have been used for decades with positive effects, there are currently very few studies that specifically describe the perspectives of healthcare professionals regarding the value of music therapy when applied in these patients.

OBJECTIVES

To describe the insights of healthcare professionals regarding music therapy, both on a personal level and in terms of its usefulness in the care of hospitalised children and adolescents.

DESIGN

This was a qualitative descriptive-exploratory study with focus groups.

PARTICIPANTS

Eighteen healthcare professionals.

METHODS

In January 2023, two focus groups, containing nine healthcare professionals each, were created to collect data regarding their experiences concerning the effect of music therapy on hospitalised children and adolescents. Before recording their opinions, all these professionals participated in an interactive music therapy session. The thematic analysis in this work was performed using MAXQDA® software.

RESULTS

Two main categories emerged: (a) the effects of music therapy on healthcare professionals, and (b) the benefits of music therapy to patients (children and adolescents).

CONCLUSIONS

Music therapy was valued positively by healthcare professionals who described the benefits its use has for hospitalised children and adolescents. They also expressed positive viewpoints regarding the use of music therapy to improve their own self-knowledge and self-care.

IMPLICATIONS TO PRACTICE

Healthcare professionals may utilise music therapists to improve patient outcomes and reduce the negative effects of hospitalisation.

Music interventions with children, adolescents and emerging adults in mental health settings: a scoping review

BACKGROUND

Music is increasingly used with youths in health and psychosocial interventions. We conducted a scoping review with the aim to provide an overview of the current available evidence on music intervention for youth in mental health settings, to inform practice and further research.

METHODS

Three databases (PsycINFO, PubMed and CINAHL) were surveyed. Using the PRISMA review method, 23 studies met inclusion criteria.

RESULTS

Young people aged from 4 to 25 years old with various mental health conditions participated in music interventions. Music therapy was the most investigated (71%). Improving social skills was the most frequent therapeutic aim addressed. Music interventions are mostly appreciated by the participants, but it is difficult to make conclusions about their effectiveness because of the heterogeneity of research designs and the limited current state of research.

CONCLUSION

Music interventions appear to represent a promising complementary approach to usual psychiatric care, but further standardised research is necessary to continue investigating their therapeutic effects.

Key features of adolescent inpatient units and development of a checklist to improve consistency in reporting of settings

WHAT IS KNOWN ON THE SUBJECT?: Little is known about adolescent inpatient units, key features which define them, and how these essential services operate and deliver care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Adolescent inpatient unit studies are limited in their descriptions of settings in terms of how they operate and key features. The proposed preliminary checklist is a practical tool to assist clinicians, policy makers, and researchers when reporting to ensure comprehensive descriptions of adolescent inpatient settings. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This could be used to inform service design processes for inpatient and other mental health service models which is of critical importance in the context of reforms and implementation of these in Australia currently. Greater attention to operational models, services, and philosophies of practice will improve reporting and allow for the advancement of knowledge, comparison of study results, and a clearer direction for mental health nursing clinicians and researchers. ABSTRACT: Introduction Adolescent inpatient units care for vulnerable population groups; however, little is known about how these essential services operate and deliver care. Aims To examine the descriptions of adolescent mental health inpatient units in Australian and international research publications and to identify key features which were used to define them. A secondary aim was to develop a checklist to improve consistency when reporting on the operations and services delivered within adolescent mental health inpatient units (both public and private). Methods Five electronic databases (CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO) were systematically searched. We included studies that provided descriptions of operations and services within adolescent inpatient units where participants had a mean age between 12 and 25. Narrative synthesis was used to explore the similarities and differences between descriptions of settings. Results Twenty-eight studies were identified, which varied in their descriptions of adolescent inpatient units, providing inconsistent information to inform best practice. Discussion Studies lack consistency and comprehensive detail when describing the operational models within inpatient units, making interpretation challenging. Consequently, a preliminary checklist is proposed to improve reporting of adolescent inpatient units.

Music therapy for adolescents with psychiatric disorders: An overview

BACKGROUND

Although it is true that adolescence is a stage of evolutionary development in which there are innumerable windows of opportunity, it is also the peak age at which some psychiatric disorders may appear. On the other hand, music is an auditory stimulus that interests and motivates youngsters, as it is used for identity, social connection, and emotional regulation.

METHODS

We conducted a strategic search by consulting scientific databases. The following search terms were employed: Music Therapy AND Psychology AND Psychiatry AND Adolescents. The following international electronic databases were searched: Medline, Ovid, and Cochrane Library.

RESULTS

A total of 142 sources were identified from which 9 papers on music therapy published exclusively in scientific journals specialized in psychology or child psychiatry were selected. The total number of participants was 651. The studies reported that music therapy interventions have the potential to improve self-esteem, social engagement, decrease social isolation, and depressive and anxiety symptoms in psychiatric adolescents (both in inpatient and outpatient settings).

CONCLUSION

Given the heterogeneity and methodological quality of the few studies included, it is complex to extrapolate and generalize results. More quality research is needed to expand music therapy interventions on youth mental health.

Effects of Music Therapy on Vital Signs in Children with Chronic Disease

Background: Recent research found evidence supporting music therapy for hospitalized children with chronic diseases. The aim of this study was to investigate the effect of music therapy on hospitalized children’s vital signs. Methods: In this prospective study, children with chronic gastroenterological and nephrological diseases received active or receptive music therapy two to four times a week until discharge from hospital at the pediatric special care unit (SCU) and pediatric intensive care unit (ICU). Baseline and post-therapy heart rate, oxygen saturation and blood pressure were recorded and analyzed as control values at three points on the same day when the children were alone in their patient room at rest. Results: A total of 83 children, median 3 age of years (range one month to eighteen years) received music therapy. In total, 377 music therapy sessions were treated: 200 receptive therapy (78 ICU, 122 SCU) and 177 with active therapy (0 ICU, 177 SCU). Music therapy interventions showed changes in vital signs during music therapy sessions. After music therapy, heart rates decreased by 18 beats per minute (95% confidence interval (CI), −19.4 to (−16.8)), oxygen saturation increased by 2.3% (95% CI, 2.2 to 2.5), systolic blood pressure decreased by 9.2 (95% CI, −10.6 to −7.7) and diastolic blood pressure decreased by 7.9 (95% CI, −9.6 to −6.3). When music therapy was applied at the SCU (ICU), heart rates significantly reduced by 17.9 (18.9) beats per min, oxygen saturation increased by 2.4% (2.1%) and blood pressure reduced by 9.2 (2.8) mmHg (systolic) and 7.9 (0.3) mmHg (diastolic). Almost all control values were better than directly before the intervention. However, after music therapy intervention, the children showed better values in vital signs compared to being alone in their patient room. Conclusion: Music therapy is an added value for children with kidney and liver/gastrointestinal diseases during their hospital stay.

Acceptability and Feasibility of Perioperative Music Listening: A Rapid Qualitative Inquiry Approach

Perioperative music decreases pain, anxiety, and analgesia requirements while increasing patient satisfaction. We investigated the acceptability of perioperative music at a women's and children's hospital in Singapore, seeking to uncover barriers and facilitators to implementation in routine practice over a 12-week period. We used an undergraduate-led Rapid Qualitative Inquiry approach that includes data collection from multiple sources, iterative analysis, and additional data collection when necessary. Participants consisted of anesthesiologists and nurses working in the preoperative area, operating room, and postoperative recovery areas. In Stage 1, nurses and anesthesiologists answered a survey assessing attitudes and knowledge about perioperative music and attended a presentation introducing the intervention. In Stage 2, the results of the Stage 1 survey were disclosed, and nurses and anesthesiologists completed a second survey (Stage 1 survey questions with an additional query about implementation). Twenty-nine nurses were interviewed with semi-structured questions on barriers and facilitators to implementation. In Stage 3, nurses retook the Stage 2 survey after one month of implementation. The implementation of perioperative music was both acceptable and feasible in Singapore. The nurses' and anesthesiologists' acceptability increased over time with mostly positive qualitative feedback. Implementation barriers, including patient interest, timing of patient turnover, and added staff workload, appeared minor and could potentially be overcome by utilizing the intervention in the preoperative instead of postoperative area, deploying music in operating rooms with slower turnover, and evenly distributing staff workload. Local implementation stakeholders may make additional recommendations for scaling-up perioperative music interventions to fit other workflows while improving the patient experience.

Registered nurses' awareness, acceptability and use of music for the management of pain and anxiety in clinical practice

BACKGROUND

and purpose: The use of music is increasingly being recommended for the management of patients' pain and anxiety by healthcare providers. The purpose of this study was to examine registered nurses (RNs)' awareness, acceptability and actual use of music for the management of patients' pain and anxiety.

MATERIALS AND METHODS

A cross-sectional design was employed. Data were collected using a mailed questionnaire.

RESULTS

RNs were aware of the use of music for managing pain (4.42 ± 2.08, possible range 1-7) and anxiety (4.97 ± 1.85, possible range 1-7), and perceived use of music as low-to-moderately acceptable (mean scores ranging from 1.48 to 3.87, possible range 0-4). Further, 46% (n = 69) of RNs reported using music in their practice.

CONCLUSION

RNs have a moderate level of awareness and a low-to-moderate level of acceptability of music, with nearly half reporting use of music for managing patients' pain and anxiety in practice.

The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care

PROBLEM

Little has been reported from clinicians about the operations, interventions, and outcomes of inpatient units and how these comprise models of care in such units. The aim of this study was to explore an inpatient model of care in operation at the study site by defining key features of the model from the perspectives of clinicians.

METHODS

Semi-structured face to face interviews were conducted with ten clinicians working in a private inpatient unit in Melbourne, Australia. Interview data were analyzed using thematic analysis.

FINDINGS

Analysis resulted in the identification of three thematic features relating to containment, engagement, and therapy. These included (a) an environment conducive to containment, (b) adolescent engagement through shared experiences, and (c) dialectical behavior therapy embedded culture.

CONCLUSIONS

The findings provide insights into often unheard clinician perspectives on what the key features of an adolescent inpatient model of care are. These features relate to the interventions that are currently offered on the unit and ways of working as informed by philosophies and practices. These findings should be used to improve clinical services and inform research aiming to articulate exemplary adolescent inpatient models of care. Furthermore, the findings provide guidance and practical information to commissioners, clinicians, and policy makers implementing models of care.

Sound practice: Exploring the benefits of establishing a music group on an acute mental health inpatient unit

There is evidence supporting the use of formal music therapy in the treatment of mental health consumers. Despite this, it appears to be an intervention which has not been routinely offered to consumers in Australian acute mental health inpatient units, possibly due to the lack of trained music therapists (or inadequate funding to employ them), as well as the challenges posed by the acuity of presentations and the short duration of admissions. Less formal therapeutic music activities may benefit consumers within these settings. This article describes how a music group activity facilitated by clinical staff with no music therapy qualifications was established. The first phase of this evaluation is then described using a descriptive qualitative method. We undertook a series of consumer and staff focus groups to explore the impact of a music group activity on an acute mental health inpatient unit. Five themes emerged from the transcripts of the focus groups' discussions, effects on mood, relationships and engagement, social connectedness and inclusion, the ward atmosphere and noise/agitation. Positive effects were shown across these areas, suggesting that the music group activity we established was beneficial for consumers and staff, and enhanced the ward atmosphere.

What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review

Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported nonpharmacological therapeutic interventions for young people admitted to general or non-disorder-specific adolescent mental health inpatient settings. A descriptive review of this nature was not located in the literature. The aim was to identify what is currently known about reported nonpharmacological therapeutic interventions. The purpose was to consider gaps and contribute to further work being undertaken in describing an exemplary inpatient model of care for adolescents. Sources included CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO. Studies included were those published in English, between the years 2000 and 2018. Exclusions included residential, community, outpatient, forensic settings, and studies detailing pharmacological interventions. Ten studies were identified. This descriptive review provides an objective foundation to inform an exemplary inpatient model of care currently being investigated. There is a critical need to understand these interventions to identify key components of an inpatient model of care. Such knowledge will provide guidance for future services seeking to create an exemplary model of care. Furthermore, these results can influence current practice by improving quality and delivery of inpatient care.