Health Care Performances – artistic awareness, sensitivity and interaction
Learning to communicate with an audience is an essential part of becoming a professional musician. Working with patients whose circumstances restrict or deny access to live music gives the musician an opportunity to develop these skills and might have a profound impact on their artistic awareness, musical interaction, reflection and development.
This artistic practice – a direct and intimate face-to-face form of communication requires presence, empathy and the ability to improvise and change the music repertoire, musical expression and intensity along the way. The patient's body language and reactions must be a catalyst for the music experience, together with artistic focus and no compromise on/maintenance of high professional musical nerve, which is a very demanding task for the musician, and a valuable artistic experience that can be used and transformed into traditional concerted contexts. "... It requires an open mind, a watchful eye, a listening ear" - guideline to musicians in the English organization Music in Hospitals (https://mihc.org.uk).
This project addresses the question on how professional artistic practice can develop in the meeting with the intensive care patient.
What are the underlying mechanisms behind this kind of artistic practice and to what extent will it deepen and create new meaning of musicianship on:
- Artistic awareness
- Empathy and sensitivity
- Musical interaction and reflection
- Performance – ”catching the moment”
How can HEI’s in the Arts develop the artist’s role in society as a ressource for change and improvement?
Live music in the health care system (LMHC) is largely a mutual interaction between patient, staff and the musician. Much is known about positive health related effects of music among various groups of patients having somatic (cancer (Bradt et al, 2016), stroke (Särkämö et al, 2008), Parkinson´s disease (de Dreu et al, 2012), dementia (Vasionyté & Madison, 2013)) or psychiatric disorders (depression (Chan et al, 2011), insomnia(Jespersen et al, 2015), autism spectrum disorder (Gebauer et al, 2013)). Furthermore, it is found that health care professionals report music interventions to decrease stress, improve mood, reduce burnout and improve the staff/patient relationship (Wilson et al, 2016). Although Preti and Welch (Preti and Welch, 2013) explored the motivations and characterization of musicians performing in health care, less is known about the musicians’ role and potential artistic benefits in this setting. Many of the musicians who have participated in the LMHC project have said that this kind of musical experience have given them a deeper understanding of their artistic awareness as well as their perception of performance ”Through this project I have become better in showing vulnerability when playing traditional concerts”, Helene Bak, pianist. Other musicians have mentioned that former problems with performance anxiety have decreased in favour for the feeling of ”cathing the moment” on stage. These examples show that there is a need for exploring this field further, to give a new meaning of musicianship, artistic awareness and development for the benefit of the individual musician, and the role of RAMA and SDMK in society, from a national and international perspective.
Live music interventions
This project is a part of a planned study at Aarhus University Hospital with the aim of investigating the effect of live music interventions among patients and staff at the Intensive Care Unit (ICU). Both qualitative and quantitative data will be collected. Critically ill patients are consistently exposed to stress and often feel isolated, confused, anxious and alienated in a high-tech environment characterized by high tempo, ambient noise-levels, and initially non-allocated alarms (Preti and Welch, 2013). Further it is found that ICU health care professionals face challenges in the risk for burn-out and emotional exhaustion (Abrahamian & Lebherz-Eichinger 2018). Pre-recorded music interventions and active music therapy have shown positive effects on stress and anxiety among patients in ICU (Lee et al, 2017) (Umbrello et al ,2019), as well as music combined with muscle relaxation has shown positive effect on stress, fatigue and coping style among IUC nurses (Ozgundondu & Gok, 2019). However, less is known on the effects of live music intervention in the ICU setting. Although Chisson, et al 2013 (Chisson et al, 2013) found a 27% decrease on pain compared to controls by offering 10 minutes of spontaneous harp music to ICU-patients, it still remains to be investigated whether patient preferred live music offered by skilled professional musicians representing different genres, constellations and instruments can meet the patients musical preference and needs. It is hoped that individualized live music can reduce anxiety and pain, create meaning and belonging by breaking down feelings of alienation and isolation during hospitalization. In the normal hospital setting, treatment is ’done to you’, whereas music intervention is conducted on an equal basis where the patient can decide whether he/she wants to participate. This might restore a sense of autonomy and connects the patient to the world outside, no matter how grave the condition is. That adds to a sense of wellbeing.
Students from RAMA and SDMK will undergo a theoretical and performative training programme after which they will play individualized music interventions for patients and staff at the intensive care unit at Aarhus University Hospital (AUH) under the guidance by Margrethe Langer Bro (MLB).
Theory and practice
The theoretical part includes an overview of international organizations and their individual approaches to live music in health care. Further, the musicians are informed on the ICU patient; their situation, treatment and possible reactions, the ICU high-tech environment, the musicians role and potential development, communication with staff, self-care, how to cope, ”music in the brain”, differentiated music communication, and choice of patient-centered repertoire. Finally, the musicians are presented to the hospital, followed by a tour in the ICU-unit, after which they fill out a confidentiality policy required by the hospital departments.
The performative part includes development of genre, artistic awareness, reflection, performance, communication skills, and supervision throughout the whole process. The music intervention will be targeted to the individual patients needs by considering choice of suitable repertoire, tempo, pitch, acoustics, musical nerve, expression and person-centered skills.
The project includes three pilot studies containing 8 music intervention sessions each. The musicians and MLB will meet in the morning for initial briefing on today's programme, including information on special conditions that must be taken into consideration according to the individual patients who are interested in participating. Then the musicians will play for the staff in the coffee-room, after which they will perform for the patients. This can be done by using existing repertoire of various genres, but also by improvisation based on inputs of patients or staff. This can for example be the description of a landscape, a color, or an emotion. Through this training a strong engagement between participants involved may develop. Each intervention-day will end up with a sum-up and reflection meeting together with MLB.
Parallel to Pilot 1 at AUH, MLB will perform and conduct a similar study with musicians from SDMK at The Hospital of Southwest Jutland (SVS). During the project, students from RAMA and SDMK will meet for reflection in plenum and two workshops by Rosalin Hawley and René van Munster, respectively, will be conducted in April 2020 and September 2020 for the whole group. Both Rosalin Hawley and René van Munster have been working as professional musicians and supervisors within the field for several years.
Additionally, during Pilot 1 at AUH and SVS, a qualitative research protocol will be developed in cooperation with professor Rineke Smilde based on the identified themes (artistic awareness, empathy and sensitivity, flexibility, musical interaction and reflection, collaboration, risk-taking, performance – ”catching the moment”) in order to clarify this artistic practice and development from an interpersonal, institutional, societal and academic point of view.
Focus group interviews
MLB will visit Rineke in Groningen, sharing experiences and attending the Meaningful Music in Healthcare (MiMiC) activities, likewise, Rineke will visit DK and witness the Danish approach. Like the Danish approach, the nature of the MiMiC activities is artistic. This means that the artistic response and the way music is experienced, are the key focus and not therapeutic, even if it concerns musical input in the medical setting. Based on the experiences in Pilot 1, the following two pilots will be adjusted and focus group interviews among the students will be conducted at the end of the project period. Overall, the interviews will addresses the question on how professional artistic practice can develop in the meeting with the intensive care patient and investigate whether this kind of artistic practice, will create new meaning of musicianship on the following areas: artistic awareness, empathy and sensitivity, flexibility, musical interaction and reflection, collaboration, risk-taking, performance – ”catching the moment”
The results from the interviews will form the basis for developing a formally defined best practice training program at RAMA and SDMK and a first step towards a publically accepted profession of being a health care musician.
The project is funded by Kulturministeriets pulje til KUV.