Meaningful Music in Healthcare (MiMiC) – A “Pas de Trois” of musical collaboration in a hospital
A clarinettist blows the first notes of “Autumn Leaves” gently while walking around the corridor of the ward of hepatobiliary and vascular surgery. The warm earthy sound fills the light corridor with a sincere melody that signals to the patients in their rooms: “the music is here again”. After this, the clarinettist and his two fellow musicians, a cellist and a flautist will make themselves available to bring the music into the patients’ rooms, but only if the patients invite them in.
Meaningful Music in Healthcare: explorative research leading to a new practice
This is a typical beginning situation of a music session at the hospital in the new participatory music practice Meaningful Music in Healthcare (MiMiC in short). The MiMiC-practice was developed in the North of the Netherlands through joint research activities between the research group Lifelong Learning in Music (LLM) and a surgical research group at the University Medical Center Groningen (UMCG) in 2016-2018. The mixed-method research took place in three surgical wards of the UMCG, reaching adult patients of 18-100 years of age in shared and individual rooms.
In the MiMiC-practice, three professional musicians work in a hospital ward daily during a week-long project. This way, the musicians can accompany some patients during their full time of hospitalisation. Each session is 60-75 minutes long, depending on the day structure of the ward. The sessions include several patient encounters, often not longer than 10-15 min per room. Each session is built upon approaches of person-centred music-making (Dons, Hendriks, Pyykönen, 2017). These approaches include improvised music that is created specifically for or with the person(s) in the moment, as well as a diverse selection of repertoire of different genres. The music is played for the patients, their caregivers and their families. There are various combinations of instrumentalists in the MiMiC-musician teams, and therefore, the repertoire is carefully arranged for every project and played without sheet music to allow undistracted connectivity within the context.
The patient encounters are facilitated by a mediator, who functions as a link between the musicians, the care professionals and the patients. The mediator makes sure that the music is brought to everyone who would like to have it and schedules the sessions so that the musicians can entirely focus on their interactions with the patients the care professionals. During the meetings in the patients’ rooms, the musicians take the patients’ physical and emotional condition into consideration to fine-tune their approach. The musicians may ask the patient (and her/his nurse) to describe, e.g. a landscape, which will be translated into music. The patients may also tell stories, sing along or conduct the musicians with a baton in the co-creative musical moments.
Although live music is offered to all patients who have a need for it, the MiMiC-practice has a particular focus on older adult patients. This is because elderly persons tend to have an increased risk of complications after surgery (Robinson & Eiseman, 2008). The risk of delirium, particularly, makes them vulnerable during the hospital recovery period. Therefore, a central aim of the joint research was to find out how shared meaningful musical moments can help older adult patients to cope with the complicated situation they experienced during the time of their hospitalisation. The researchers of the UMCG conducted physical measurements and questionnaires before, during and after the music session to find out how music helped with the older patients’ experiences of pain, stress and anxiety. The early findings on the impact of live music on the patients’ pain perception have been encouraging.
Mutuality as a core of the practice: the invisible choreography of a “Pas de trois”
In the development of the MiMiC-practice, the approach was explorative and equally inclusive of all participants of the musical situation: the patients, the care professionals and the musicians. Thus, the practice is rooted in recognition of a fundamental underlying mutuality. It can be described as a “Pas de trois”: a dance in ballet that is shared by three dancers. In the MiMiC-practice, the dancers are the musicians, the patients and the care professionals partaking in the musical co-creative interaction.
For the researchers of the LLM, the mutuality meant that it was important to investigate beyond the impact of the music for the well-being of patients. Thus, they sought to find out what interactive music sessions mean for the well-being and learning of health care professionals, what kind of learning takes place for the musicians working in the practice, and what kind of decision-making underlies their interactions with the patients within the context. Moreover, based on the development of the MiMiC-practice, a new training module “Music & Healthcare” was developed to prepare novice musicians for the new working context. The module is offered at Prince Claus Conservatoire of Hanze University of Applied Sciences in Groningen from February 2019 onwards.
The perspective of the learning of care professionals and the meaning of the MiMiC-practice for their occupational well-being is connected to and part of my PhD-research ““Getting Closer” – The Legacy of Applied Participatory Music Practices with Elderly People as a Resource for Healthcare Professionals”. In addition to my researcher-position in the practice, being a MiMiC-musician helped me to gain a closer look at the music sessions.
Person-centredness in focus
Based on these two perspectives, musician and researcher, I have found person-centredness as an overarching aspect of the MiMiC-practice. In healthcare, and especially in elderly care, person-centredness is essential to building a dialogical care relationship (HIN, 2016). Person-centredness is not only crucial for the patient’s experience of the care but also for the professional satisfaction and meaningfulness of the work for the care professional.
As previously explained, in the MiMiC-practice, the musicians use person-centred approaches of music-making. At times, the hectic realities of the work-life of care professionals hinder their connectivity with their patients. Yet, my research data suggests that by participating in the MiMiC-music sessions, the care professionals can share meaningful musical moments with their patients, which can help them to form a deeper care-relationship. In fact, the shared musical experience can help to establish (or deepen) a care-relationship, which is in the core of providing person-centred care. Thus, the value of person-centred music-making is recognised by both the musicians and the care professionals. According to one medical nurse, the MiMiC-music sessions also help to create an equal space to meet between the nurses and the patients: having “a human relationship instead of nursing and care”.
Furthermore, the analysis of my research suggests that the impact of the MiMiC-practice on care professionals lies in participation. Participation can, however, take many different forms. It can be active involvement in the music-making, or on a busy workday, it can be listening to the music in the background while giving care. Even then, music can change the atmosphere and the mood on the ward. One nurse said: “I noticed that I became really joyful while doing my work, and I was whistling a little, and other colleagues were also whistling along with me”.
Furthermore, every morning, the musicians play for the care professionals of the hospital ward before starting the session with the patients. During these morning music moments, music comes close to the care staff. They refer to them as “luxury moments”.
Finally, the care professionals see often new sides of their patients through taking part in the music sessions. This has to do with the emotional release that the music offers for the patients, which can give new insight to their nurses of how they are coping during the hospitalisation. When the patients are enjoying the music that is made especially for them, the care professionals often experience sympathetic joy (Ricard, 2013) for the patients’ delight in the moment. Sometimes, as an outcome of a MiMiC-music session, the patients become more cooperative towards the care procedures that follow, which can have concrete benefits for the nurses’ work.
A peek into the musicians’ learning in the MiMiC-practice
In the practice, the musicians have found a new audience through learning how to fit into and find their place in the hospital environment. The musicians are earnest over the quality of their music-making, and they want to give their very best to each patient they meet. They have gained new knowledge of how to engage both patients and care professionals in the music sessions and how to communicate with them. Furthermore, they have learned how to balance the tensions of privacy and openness, arts and healthcare, institutional rules/guidelines and artistic freedom. They have learned how to make person-centred music in different new ways, without becoming living jukeboxes themselves.
Also, they have found their role as an insider in the musical situations and outsiders as visitors in the patients’ rooms, which is their personal space. The intimacy of the musical connection that takes place by the patient’s bedside or in the nurses’ coffee room is often reflected by the musicians. They express a longing to establish and create such authentic connectivity also outside the hospital in their conventional concert contexts.
Finally, there is enormous mutual respect between the musicians and care professionals, and the collaboration they have developed through participation in the MiMiC-practice is equally appreciated. These developments are not only necessary for the legitimation of the musicians’ position in the hospital but also for recognising and supporting the learning possibilities and meaning-making of the practice for care professionals. And so, the dance of the “pas de trois” continues.
About the author:
Krista de Wit (née Pyykönen, MMus, MMusEd) is a teacher-researcher at Prince Claus Conservatoire of Hanze University of Applied Sciences in Groningen, the Netherlands. She works in the research group Lifelong Learning in Music of Hanze University of Applied Sciences Groningen. The research group examines questions about the relationship between musicians and society, engaging with new audiences, and the learning of musicians in diverse musical contexts.
Krista carries out her PhD-research at the Music Education Department of the University of Music and Performing Arts Vienna, Austria. Her research investigates what participatory live music practices can mean for the learning and well-being of healthcare professionals in nursing homes and hospital settings, and how these practices can contribute to their working culture. The PhD-research is anticipated to be defended and published at The University of Music and Performing Arts Vienna in June 2020.
Furthermore, Krista works in the joint European master programme “New Audiences and Innovative Practice” (NAIP), where she recently chaired the NAIP-working group “Online Learning” within the framework “Training Artists without Borders” (2016-2018). Krista was previously part of the NAIP-faculty at the Royal College of Music in Stockholm, Sweden (2013-2015). She gives lectures on her research topics and continues to work as a violinist in different community contexts.
Dons, K., Hendriks, L. & Pyykönen, K. (2017). Meaningful Music in Health Care. Hanze University of Applied Sciences Groningen: Research Group Lifelong Learning in Music.
Health Innovation Network South London. (not dated). What is person-centred care and why is it important? Retrieved from https://healthinnovationnetwork.com/system/ckeditor_assets/attachments/41/what_is_person-centred_care_and_why_is_it_important.pdf(1.9.2016).
Ricard, M. (2013).Altruism. The Power of Compassion to Change Yourself and the World. New York: BackBay Books/Little, Brown and Company.
Robinson, T. N. & Eiseman, B. (2008). Postoperative delirium in the elderly: diagnosis and management. Clinical Interventions in Aging. 3(2): 351-355.