Care Setting
Community care
Evidence Base for Practice
“Music Therapy is an allied health service similar to occupational therapy and physical therapy. It consists of using music therapeutically to address physical, psychological, cognitive and /or social functioning. Because music therapy is a powerful and non-threatening medium, unique outcomes are possible. In addition to its applications with elderly persons, music therapy is used successfully with all ages and disabilities.” (American Music Therapy Association 2005).
Gillam (2003) evaluated a music workshop which was established in 1995 to;
“encourage people to develop interpersonal skills through improvisational groupwork.”
The evaluation produced a positive outcome and was supported by the findings of Silverman and Marcionetti (2004) who conducted a pre- and post-test design on eight music therapy sessions. The post-test results, with the exception of a lyric group result, demonstrated increased scores based on alleviation of specific mental health deficit areas. The patients’ rated the sessions as improving aspects of psychiatric deficit areas in 97.5% of sessions.
Silverman (2003) also conducted a meta-analysis on the effects of music therapy on symptoms of psychosis.
“Results indicated that music has proven to be significantly effective in suppressing and combating the symptoms of psychosis.”
In addition to music being simply a device to alleviate symptoms and promote interpersonal interaction, Rolysjord (2004) discusses the music therapy philosophy of empowerment of mental health patients through the focus on their strengths and potentials, and the importance of the collaboration and equality between the patient and therapist.
Quality assurance/impact of practice
Discussion
All participants demonstrated an increase in total score between 7 and 35. The summary graphs (available from contributor) display the trends of the specific elements. It was significant that the unique opportunity afforded by music therapy to articulate feelings through music, increased in all participants as did their confidence scores. In addition, the element of relating to others increased in all but one of the participants.
The interview responses provide some qualitative evidence to support the results graphs as the following responses to questions 1 to 3 demonstrate:
Participant 3 was not interviewed due to the discharge from the day hospital.
Question 1 on positive changes
Participant 1: “Yes, a lot happier. In the past I never played any instruments. It was nice to have the opportunity to play lots of instruments.”
Participant 2: “Liked the group, gave more confidence.”
Participant 4: “You think about music more than you used to. Enjoyed coming to the group. Got better insight into various instruments and how they were made.
Participant 5: “Always interested one of my main interests. Enjoyed the experience.”
Question 2 on others noticing change
Participant 1: “Yes, my friend noticed since attending day hospital and group – everyone’s friendly.”
Participant 2: “My daughter was talking to my other daughter and had noticed I was more chatty.”
Participant 4: “I have a CD centre at home. My family have noticed that I’m now using it and have an incr
Practice Summary
A proposal was submitted to the Old Age Psychiatric Service in November 2005 for a joint occupational therapy/nursing/music therapy project to evaluate a period of music therapy intervention of 12 weeks (one session per week). Ten sessions between January 2006 and April 2006 were conducted with the participation of five clients from Forthview Day Hospital. The clients were selected by the Senior Charge Nurse based on their need to develop confidence in preparation for discharge. All the participants were over 65 years old and presented with functional illnesses. Three participants also presented with mild cognitive impairment.
Practice Detail
Ten sessions between January 2006 and April 2006 were conducted with the participation of five clients from Forthview Day Hospital. The clients were selected by Theresa McQuade (Senior Charge Nurse Forthview Day Hospital) based on their need to develop confidence in preparation for discharge. All the participants were over 65 years old and presented with functional illnesses. Three participants also presented with mild cognitive impairment.
Janet Neil (Senior Music Therapist) led the programme assisted by Michelle Fleming (Staff Nurse Forthview Day Hospital) and Gael Lindsay (Senior Occupational Therapist). Two participants completed ten sessions, two completed nine, and the remaining participant completed eight sessions.
The format of each session consisted of the following elements:
o Introduction/Warm Up: “Hello Song.”
o Choosing Instruments: alone or in pairs.
o Choosing Instrument: for improvisation with the music therapist.
o Reflecting on the session and associated feelings.
o Closing song.
The duration of each session was 45 minutes (not including setting and clearing up.)
Challenges
A music therapy outcome measure was used to evaluate the response of each participant on a weekly basis (see Appendix I) in relation to the following elements on a 5-point Likert scale:
o Motivation.
o Mental State.
o Mood.
o Self Confidence.
o Insight.
o Relating to Others.
o Articulation of Feelings through Music.
A semi-structured interview was also conducted on the remaining four participants, (see Appendix II).