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Sara Fawcett Reflective Essay for Musicians in Healthcare Mentoring Programme Delivered by rb&hArts and Sound Connections

INTRODUCTION

The musicians mentoring programme that I completed with rb&hArts over the last five months (Mar-Jul) has given me practical experience of providing music in a clinical environment. It has been a phenomenal experience.  I have had the opportunity to work with an amazing group of talented musicians in intimate settings with patients and their families.  Through the course of the programme I witnessed the improvement to patient wellbeing that musical interactions can foster.

In this essay I will focus on how our musical interactions affected patients, and what I have learnt through the programme about being a musician working in a clinical setting, including the challenges and the rewards.  I will also touch on how the sessions have expanded my own skills as a musician.  I hope this will be helpful to others who may be considering building a music practice in a healthcare setting.

THE CONTEXT

I shadowed a range of musicians who work with rb&hArts, including vocalists, a violinist, and beatboxers.  They were exceptional musicians with strong musical and interpersonal skills which combined meant they were able to ensure everyone on the ward experienced music in an inclusive and dynamic way.

The musicians were confident and comfortable in the clinical setting providing patient-focused sessions in a busy ward whilst remaining highly aware of the clinical activity going on around them.  This was particularly impressive given how busy the wards could be with medical staff carrying out their duties around the musicians as they delivered their sessions. 

PERSONAL AIMS AND OBJECTIVES

The chance to join the programme came at a key point in my career as I look to train as a music therapist in the coming year.  Ahead of that I have been focusing on expanding my musical experience to develop an understanding of how music can improve patient health and wellbeing.  I was therefore extremely excited to have successfully secured a place on the scheme.  I completed 35 hours of shadowing over the five months.  I also hope to continue on a volunteer basis working with rb&hArts and am exploring how I might begin similar work elsewhere.

I had three personal objectives as I took part in the programme.  These were:

  • To understand the particular challenges in delivering music in a clinical environment;
  • To identify the skills needed to deliver music on the war
  • To develop a suitable repertoire for music provision on the ward and gain confidence in singing to patients.

WORKING IN A CLINICAL SETTING

I have never experienced what an ICU or HCU environment is like, and my first sessions on these wards was challenging. The majority of the patients on the ICU were sedated and surrounded by a lot of machinery.   It took me a while to adjust to the intimacy of the setting, particularly in terms of performing to the families gathered around the beds.  

The children’s ward also took me time to adjust to.  Not least because of its vibrant nursery vibe which was in stark contrast to the clinical activity.  I was also acutely conscious of how ill some of the children were.  I had not anticipated how affecting this would be. 

A few examples of the kinds of environments we worked in were:

  • Isolation ward:  This setting was very intimate as we joined the family and patient.  The music was very much a family focused process enabling everyone to join in and create a moment together.  There were a few instances where the patient was particularly unwell and we wore protective clothing as we played with them.  This took adjusting to, but the support of my music mentors enabled me to relax.
  • HCU:  Patients were able to interact with us and were keen to talk and take part in the music making.  Again the intimacy was striking, we were quickly sharing the musical memories of patients who reminisced about their favourite tunes and talked about how important music was to them.
  • ICU:  working on this ward had a profound impact on me.  It was very disconcerting to see so many patients sedated.  While we played to the patient, we relied on the family members to talk about the patient and their musical preferences.  These sessions enabled the family to recall the qualities of the patient went they were well and it was lovely to see the positive effect this had on family members.  
  • Children’s ward:  A vibrant setting that catered to children in terms of making it as cheerful as possible.  But there was no escaping the fact that some of the children were very unwell and had serious medical interventions.  Working with the musicians on this ward also had a profound impact on me.  It required a level of resilience I had not appreciated, at this same time it was incredibly rewarding.

EXPERIENCES

Every session on the ward was rewarding for different reasons.  I’ve highlighted a range of experiences that illustrate the different interactions that music on the ward enabled and how that helped the patient/family.

Working with mentors was extremely beneficial.  It enabled us to observe how they interacted with patients, and discuss the sessions and any issues that came up. For example, after the session in the ICU, I reflected with Adrian on how intrusive the sessions could have felt if not handled as sensitively as he had handled them.  Adrian brought a sensitive humorous approach that cut through the very clinical and alien environment.  

The following gives some examples of our musical interactions:

  • ICU Family group around bedside:  Adrian greeted a family group who were gathered around the bedside of a patient with a cheery “hello family” - they responded clearly intrigued by him in his tails and with his violin.  He quickly engaged them in a lively conversation about music. 
  • ICU terminally ill patient:  We had a very moving session with a terminally ill patient. We played the song “love me tender”(me on Uke, Adrian on Violin) and its as the music unfolded, the patient began to respond opening his eyes to look at Adrian and reaching out towards him.  The patient listened intently and seemed more at ease as the music came to an end.  His mother noted afterwards that this was unexpected and she was clearly very moved by the experience. The session demonstrated how music can foster a sense of calm that clearly had a profound effect on the patient.
  • HCU:  We joined a family in the social room who were doing a puzzle.  Adrian asked if they would like any music and we quickly chatted about old songs.  In particular the patient mentioned his love of Vaughan Williams.  Adrian began to play the opening of Lark Ascending and the patient immediately began to cry.  He explained that it brought a memory of his mother back to him and he was deeply affected by the music in a positive sense as he recalled his love for her.  

SINGING FOR BREATHING SESSIONS

These were a real joy to participate in. The patient groups were evidently extremely happy to be in the group and it was clear from their feedback that they loved the sessions.  The energy was amazing.  The patients were alert and listening intently to the instructions given by the music leaders.  It was incredibly uplifting to hear them sing.  One lady said this was the highlight of her week and it wasn’t just because of the clinical benefits the music had on her breathing.  The music and the camaraderie bonded the group together outside of their medical conditions.  All the sessions I attended for singing for breathing had the same fun quality.  Each group had deep praise for the music leaders (Ed and Elisa).  I was struck now they were enthralled by them and clearly had a huge respect for their skills.

SINGING ON THE ADULTS WARD 

Providing music on these wards was a real pleasure.  Over the course of the programme I met a lot of patients through this process.  Without a doubt the music had an overwhelmingly positive impact on the ward (patients and staff).  Feedback was overwhelmingly positive.

A clear pattern in the sessions emerged: while some would welcome the music, others were skeptical, but after just one song, they invariably asked for another song.  The patients were often visibly moved by Stac’s singing and this opened up discussions about music and personal stories that were incredibly touching. Examples include:

  • On two instances ladies in the ward danced with each other as we sang and played.  The sense of community and bonding that the music initiated was evident in the overwhelmingly positive feedback we received.  There were many moments where patients were visibly happier then when we had first entered the ward.   
  • Another patient talked about his Italian family and how he had grown up with music.
  • One patient talked about how she had loved dancing to the music we had played as a young girl.  
  • An elderly patient sat quietly listening as Stac sang ‘La Vie En Rose’ appearing to have been transported to another time and place.  

Some specific feedback included how the music had in some cases helped patients temporarily forget their pain.  We had also witnessed how it had enabled a moment of closeness when a mother and daughter had got up and danced together.  They commented that this was the first time since the operation that the patient had got up - they had been inspired to move by the music.  There were many examples like this which demonstrated how effective the music was in enhancing the mood of the patients.

THE CHILDREN’S WARD

I found the children’s ward the hardest to adjust to having never been exposed to children who were this unwell and in this environment.   Over the course of the programme my confidence increased as I became more used to the ward. And it was incredibly rewarding work.  But it calls for a high degree of resilience.  I was extremely impressed with the musicians’ ability to enable musical sessions that delivered positive experiences for all the patients.  And again having the benefit of an experience mentor to discuss the issues with was very helpful.  This allowed us to work through the emotions that came up during the sessions and reflect on how the music would have benefited the patients.   Some examples of the sessions are below:

  • Enabling mother/child bonding:  On two occasions, the music facilitated mother/child interactions that strengthened bonding between the two.  In the first session, Heather and I began playing as the father was feeding his young child.  As we played, the mother got up and came to her child’s bedside, taking over the feeding and interacting with her baby as we sang.  In the second example a mother was struggling to comfort her young baby we started to sing a lullaby and over the course of 20 min the baby settled in her arms and eventually slept.  The mother commented that she had struggled to soothe the baby previously without the music.
  • Helping children express themselves through music:  On two occasions we facilitated sessions in song writing with two young children.  The lyrics were determined by the patients with Heather helping them shape their ideas into musical form.  The songs were a great way of creating a memory that the family could keep.
  • Enabling play through music:  Using a range of songs we invited interactions between parents and their children.  The focus on a musical instrument allowed a concentration on something else and in one case, this enabled an episode of fun making animal noises and mirror the patients activity through the music.  
  • ECG Monitoring:  In one session Heather used music to help soothe a 2-year-old patient as she was prepared and monitored for an ECG.  With their little girl’s dad she identified her favourite songs and together they sang. Subsequently the nurse noted how calm the child was during the procedure.

KEY LEARNING AND TIPS 

Be prepared to play anything!  The ability of the musicians to adapt and play music that the patients were familiar with was impressive.  Having a good repertoire of songs is essential but also being prepared to improvise with patients is important.

Keep it simple:  A simple arrangement of a popular song can have a powerful effect.  On numerous occasions we witnessed how even just a short snippet of music can trigger strong emotions as was the case with Adrian playing the opening bars of the Lark Ascending.

It is as much about listening to patients as it is about playing:  The music is a vehicle for an interaction that enables patients to think about something else and music is a universal language which enables patients to reconnect to instances when they were not ill.

Look for opportunities to include everyone: a simple act of leaving an instrument on a patient’s bed can entice them to begin playing as the music develops.

Making music that is personal to the patient:  On all occasions, the musicians would seek to engage the patient drawing on them for inspiration - this was as simple as using the patients dolls in a song e.g. wheels on the bus, or inviting the family to make up the line to a song we were doing together.

CONCLUSION

This is a unique programme.  I would not have access to working in a hospital without it.  And I am grateful to have been a part of the programme.  It is important as music in healthcare develops more musicians like me are able to experience working on a ward. I am more confident now that I could do similar work elsewhere.  I am therefore exploring opportunities and seeking to secure funding to carry on with this type of work if possible.

In terms of my personal development as a musician, it’s clear that my general musicianship has expanded with the programme.  As a pianist I could not use a piano on the ward and therefore played the Ukulele and sang.  This was a great way to accelerate my skills on both instruments.  I have improved over 150% as a result of shadowing Stac on the Adult wards.   I am more confident in my singing and have a much more versatile repertoire than when I started the course.

The programme confirmed that I have the interpersonal skills suited to this work.  And it has confirmed for me that this is the kind of work I want to do.  Having positive feedback from the programme that supported my instincts for this work has been crucial in helping me decide my next steps. I was able to experience what it means to work with patients and the effect that can have with the security of a mentor to advise and support me as I gained more resilience.

rb&hArts and Sound Connections are currently recruiting for the next cohort of music mentees with five spaces available. 

Learn more and find out how to apply here.

DEADLINE EXTENDED to 23rd October 2019.