Live music interaction at the patient bedside provides an opportunity for patients not to feel alone, to feel cared for and to feel listened to. It can allow distraction from the immediate environment or from unwelcome procedures. Importantly it can readdress balances of power, identity and ownership.
In a new initiative led by Dr. Julia Humphreys in partnership with award winning arts and health organisation LIME arts, students undertaking the PEP in narrative medicine in music, writing and art at The University of Manchester Medical School are invited to explore the paediatric hospital setting through the eyes of musicians who have developed their practice specifically for the clinical environment.
This new module introduces many 3rd year students to the paediatric hospital setting for the first time, and brings together a collective interest from students and musicians in exploring clinical care within holistically designed practice – and places the children who find themselves in need of care at its heart. Musicians are part of larger family of staff – play specialists, teachers, teaching assistants and giggle doctors- who play their part in helping to humanise the hospital setting.
But what does hospital music practice specifically contribute to medical student training? Musicians Ros Hawley and Mark Fisher give their perspective:
“During the module medical students are invited to think about the auditory environment of the hospital, and how this may impact on patients, families and staff. They are also encouraged to take this exploration further in considering sound as a multi-sensory experience. Through observation and practice of the techniques of interaction and communication used by the musicians in their daily sessions on the wards, the students experience for themselves how the approaches used in hospital music making can inform communication with patients.
Our approach is largely nonverbal: music and sound-play invite children, families and staff to experience the effects of live music through non- pressured communication. Children can participate at their pace in activities that ‘listen’ to them – following the intention and ‘voice’ of the child. Conducting the musicians to play fast or slow, leading music making with specially selected percussion instruments, or using vocalisation and gesture to direct the mood of the music are common activities in our sessions.
Whilst our work may seem to be about playing, it is just as much about listening. Observation of the tiniest of gestures is crucial in order for us to be responsive to a patient’s communication. These include changes in eye contact, head turning, facial expression and movement of hands, feet and legs. We watch closely to see if a child’s breathing relaxes upon hearing the music.
We assess and observe signs of anxiety that can present in long term hospitalised patients who are fearful of approaches to their bedside. Oxygen saturation rates may increase, and a high heart rate may reduce as a patient relaxes. The music may aid in helping a child in being able to sleep and rest. We think carefully in our music making about tone of voice, dynamic level and use of silence, so that we can adjust to each patient as appropriate. Our physical communication, shown in the pacing of our movement towards and around the bedside and the flexibility of our bodies, is always an important element of our musical interaction with a patient. Every child is an individual, and we must be ‘tuned in’ to their situation, and their communication with us.”
Medical student Sophie McKenna, a participant in the PEP this year, shares her insights into the benefits of this experience:
“Our time with the musicians based at Lime Arts was so valuable because it allowed us to ‘try on’ a different identity to that of ‘medical student’ or ‘health care professional’. Medical student training has been revolutionised in its approach to communication skills, but we are still relatively limited by the process of learning these skills via frameworks and steps that help us navigate certain situations, such as breaking bad news. Losing these frameworks and protocols was freeing, as it stripped down the interaction and enabled us to focus on the reactions and cues from the patients we were playing music with.
The non-verbal aspect was key to this – with no language there was no pressure to follow a structure and say the right things, and we could focus on body language and interaction via the music. It also shifted the power balance back to the patient, who directed and shaped the music via his/her reactions. This back and forth collaboration in music making helped build a trusting relationship between musician and patient.
Music also transformed the atmosphere on the ward, blending and harmonising with machine beeps and other clinical sounds; a relief from the strange mix of stress and banality that might be felt on a paediatric inpatient ward. This was palpable in our observation of patients, their relatives and of the clinical staff.
The use of music and the arts in general in healthcare is not a new concept. However it is not something that we see very often in practice. As well as benefiting patients, participating in projects such as this can help students to approach communication from a different angle, promoting a more nuanced and attentive approach to patient interaction.”
Ros Hawley, Mark Fisher and Sophie McKenna