Personal reflections from the Wishing Well musicians in healthcare

To help us learn more about the impact of music making in hospitals on our team of musicians, the healthcare professionals they work with and the children and families they support we commissioned an evaluation from Dr Anneli Haake. Dr Haake carried out a thematic analysis of the reports that the Musicians write up as part of their reflective practice as Musicians in Healthcare.

Her independent study found results suggesting a number of things:

  • the Wishing Well programme has positive effects for patients, families and caregivers
  • a balance is needed between welcoming staff’s assistance in prioritising which patients should take part in the music activities and allowing the musicians to use their expertise when approaching patients, in order to achieve the most positive outcome for patients
  • opportunities for musicians to practice self-care are necessary in order to avoid “burn out” and emotional trauma
  • Building and strengthening relations with staff seems helpful for these types of music making programmes

Dr Haake writes, “The musicians all observed positive effects for the patients, consistent with research on the effects that music in children’s hospitals can have. These included enhancing cognitive abilities, communication skills, and physiological abilities. The parents/caregivers also responded positively to the music sessions, which is likely to have a positive effect on the child.”

The report highlights how effective music making can be in reducing the anxiety of children and young people in hospital:

One of the nurses told us we were needed in medical ward, and that a member of the medical staff had asked for us to visit a young person who was currently having a panic attack due to pain. We arrived at the bedside and the young person was visibly distressed, with shallow rapid breathing, visible tension in the face and body, and wincing vocal sounds. A member of the medical staff was on one side of the bed and mum was on the other. The medical staff was speaking gently to the young person to try to calm him, and saying “just focus on the music”. The young person’s’ breathing became slower and more regular, and their body visibly relaxed, until they reached sleep. The medical staff thanked us after, saying “that was perfect”.

The positive effects for parents were also shown to be widespread, from helping to build positive memories and experiences of parenting as part of a child’s end of life care to helping parents grow more confident in bonding and communicating with their children in a hospital setting.

Dr Haake explains the staff worked in synergy with the musicians, recommending their patients for musical interactions and briefing the musicians on the challenges the children and families were facing. Both musicians and staff found they could work most effectively to improve the experiences of children in hospital if they worked together.

To read the full report on how Wishing Well is making a difference to the lives of children and families in hospital, head to the Wishing Well website’s new evaluation section.

New film shows the musician’s side of working with people with dementia

A little while ago, our Wishing Well programme with people with dementia was featured on BBC South East. Shortly after, we received a very moving letter from the daughter of one of our participants, thanking us for, “giving me my Mum back, albeit briefly”. She had seen her Mum on the film, smiling gently and singing song lyrics with our musicians. Her response was subtle, but showed more engagement than her daughter had seen in many months. It brought her comfort to know that her Mum could still experience joy.

It takes skill to create a musical interaction on a busy hospital ward; to work with someone with dementia to find that song from their personal sound track that holds so much meaning for them it brings them back into the world. Our Musicians in Healthcare are all professionals. We have in depth training and a strong vocation to do this work as well as a deeply held belief that no-one is beyond the reach of music, based on personal experience of hundreds of interactions and a growing evidence base from the media and academia.

Our new short film, funded by Arts Council England and made by Sarah West of West Creative explores how we use music making to build a bridge across the anxiety and isolation that the condition causes and to help people connect with the world around them again. One Nurse described this as like “watching a flower unfurl”. I hope the film encapsulates that.

Jo White, Wishing Well Programme Manager

Giving disabled children the chance to take control: A mentee’s reflections

Our Musicians

We had a visit recently from the amazing, Sophie Partridge who is an actor, writer and workshop artist. She is currently taking part in a mentoring programme with Drake Music and her mentor is the equally amazing, Graham Dowdall who also works with us here at Rhythmix.

As part of the mentor programme, Sophie got in touch to ask us if she could come and see Graham working on our project at Chailey Clinical Services in East Sussex. This project is part of our Youth Music funded Wishing Well programme which takes participatory music making into healthcare settings across the county.  Chailey Clinical Service is a residential ward for young people with very complex health needs and disabilities. We were delighted to welcome Sophie to the project; here are her reflections (we have changed the names of the participants)


As part of my mentoring with Drake Music, I asked my mentor, Graham Dowdall if it would be possible for me to observe his sessions at Chailey Clinical.  Graham’s sessions involved him working 1 to 1 with a small group of disabled young people, who varied as much in age as impairment but other than that, I wasn’t sure what to expect.  That label of `profound & multiple disabilities’!

If I had a preconception about attendees of such a session at Chailey, it was that these would be disabled people who, with the best will in the world, are done “to” and  “for”.  Through working with Graham, I knew that the aim of the session was to provide an opportunity for people to do for themselves and that can only be a good thing.  When Ben woke up, his Support Worker said “Bet you’re wondering why you’re not in bed!” (with that cold I would have wanted to be!).

Our Musicians

This for me, this seemed an indication of how little control Ben and Jack have over their lives.  To be able to exert any influence at all over their environment and activities, even if `only’ activating sound through an app, is therefore  important.  It is a “can” amongst the “cant’s” of a disabled person’s experience. I have no problem with all the “cant’s” in my life but I very much value my “cans” and have a feeling so do Ben and Jack.  They asserted themselves in the session and through their own actions. It takes communication, trust and time between all those involved; Ben and Jack, Graham as `facilitator’ and the support workers to achieve that.

Both Ben and Jack, with what I felt to be considerable effort on both their parts, activated soundscapes through minimal hand movements across iPad screens.  Although unable to hold the more ‘traditional’ instruments, Graham used them to accompany their iPad soundscapes and music was made.

At the beginning of the session, it seemed we wouldn’t take up the allotted 2 hours as there were only 2 participants but even with the health challenges encountered, challenges that are everyday occurrences for both young men and those who support them, we reached the end of that time easily.

I enjoyed the session.  I think Graham, Ben and Jack and those that supported them did too.  When people are nonverbal, enjoyment and satisfaction are expressed differently; eye contact, hand gesture and a smile of recognition and appreciation of someone’s presence with joint effort to access music, say just as much as words.  And being able to initiate sounds & music of your own choosing!  No one need be powerless or without control, devoid of pleasure or expression what-ever their needs are.  I just hope Ben and Jack  have these opportunities increased.


Sophie’s observations really get to the heart of Graham’s work at Chailey. This is patient, frankly quite tricky work and Graham has devoted hours and hours into a building a relationship with these young men that enables them to be creative in their own way and that allows Graham to recognise the subtle signs of engagement, experimentation and creativity. Ben and Jack are full time residents at Chailey and their opportunities to engage with people, things and ideas from the “outside world” are more limited than any of us can really understand.

But once a week, Graham arrives. Graham is a community music legend who is responsible for training most of our team here at Rhythmix, myself included (he likes to remind me that I wasn’t the best student back in the day.) His commitment to finding a way to make music with Ben and Jack is extraordinary and he does it in a way that is completely appropriate to their musical tastes. It’s a bit uncomfortable to talk gender sometimes but it’s been important for these young men to have a male figure in their lives. The staff at Chailey told us a long while back that they are surrounded by female carers, nurses and support workers. They have no other men in their lives; let alone one with whom they could make a bit of dubstep.

Our huge thanks to Sophie for visiting our work and sharing her thoughts with us. You can find out more about her work here: http://sophiepartridge.co.uk


 

Jo White

Programme Director for Wishing Well

Rhythmix

 

A Paramedic’s Perspective

For one reason or another, I got to spend a little bit of time recently  in an ambulance with a paramedic from my local hospital.

I talked about how making music can help to reduce the boredom and anxiety experienced by children who spend long weeks and months in hospital and how the sound ecology of hospital wards can have a very negative impact on young people. I told him about some of the older people that we work with who are living with dementia; people who can’t remember who their own daughters are but who can sing along to every line of “Fly me to the Moon”.

I expected a bit of cynicism back or maybe a polite nod, but the Paramedic grinned and handed me his iPod. It was loaded with songs from the 1930s, 40s and 50s.

He said that he assessed a lot of older people in his job and that a lot of those older people were living with dementia and got understandably anxious about the journey to hospital. So he rigged up a speaker system in the back of the ambulance. He plugs in his iPod and plays music that he thinks might be familiar to the people he meets. He said it is just incredible how much it reduces their anxiety.  He’s a musician himself and likes to sing along. The music gives him something to chat about; it creates a connection.

I am so often struck by how many professionals I meet in the NHS who completely get why music is so important to the people they look after and who can articulate the benefits of either listening to or taking part in music far better than I can. And while proper evaluation and research is vital, in my experience, healthcare professionals do not doubt what they see with their own eyes. They absolutely know what a child experiencing the joy of music looks like. I am reminded by this meeting of how much we have learned as an organisation from healthcare professionals who seek to care for, as well as cure; who see the child beyond the health condition and who understand the place of music alongside clinical interventions.

3 years on I am still blown away by this statement made by Dr. Kamal Patel one of our “champion” Consultants at The Royal Alexandra Children’s Hospital.

“There is no medicine that I can give a child, that makes them light up the way that music does. Music…helps me be a better therapeutic agent for the children I look after”

As we drove along, the inevitable questions were asked about what I do for a living and I told him about “Wishing Well”, the Music in Healthcare programme I manage for Rhythmix.

Last year we were asked by the Brighton and Sussex Medical School to run an optional Music in Healthcare module for student Doctors as part of their third year studies. The eight-week module enabled the students to tap into their own musicality and to use this to create interactions with children in the High Dependency Unit at The Royal Alex. I was impressed by the students. They clearly grasped the skills needed to make music with very poorly children and could see how these same skills would help them be better Doctors. Skills like sensitivity, trust building, creative thinking, team work, self-reflection, mirroring and observation.

One student’s comment particularly struck me:

“I have finished my Paediatric medical training but no one has taught me how relate to children. I am in my early twenties, I don’t have any younger siblings, nieces or nephews. I have never actually picked up a baby. This course has given me a way to build trust and rapport with children and I feel much more confident for it.”

This year we are running our Music in Healthcare module again. Working with student-doctors gives us an opportunity to demonstrate how Musicians can be used as a resource in acute hospital settings, to advocate to a wider audience and hopefully to broaden students perceptions of how they can help their future patients in a wider, more holistic sense. They may end up working on a ward with a participatory Music in Healthcare programme where they can support the integration of music into the daily life on the ward. They may incorporate simple techniques and ideas into their own practice, using simple songs or percussion games to build trust or to distract an anxious child. Like the Paramedic who bothered to think about how he could use music to reduce anxiety. He didn’t need to run a clinical trial or raise thousands of pounds to do this. He loaded an iPod and bought the right lead with him to work.

Towards the end of our journey, as we approached the Hospital, the Paramedic said to me “There is no culture on earth that doesn’t make music. Its universal. I don’t understand why music isn’t integrated into hospital care”.

I thought “That sounds familiar” and said “No, me neither”

A new Blog by one of Our Trainee Musicians in Healthcare, Gary Cunningham

Would you like to dance?

Not a question I get asked every day, especially in a ward full of elderly patients living with dementia. I looked around at the staff for signs that this maybe a bad idea, maybe I had to decline politely? The participants and staff did not seem shocked or bothered by the question. In fact, many were displaying sly smiles. Courteously I obliged, standing up I thought about how I would handle the situation. I must be gentle, I scanned the make shift dance floor trying to note potential hazards, trying to make sure that the dance would end with us both on our feet. Gently I took her hand and the musicians started up a rousing version of She’ll Be Coming Round the Mountain.  I was twirled and controlled and made to perform as if I was in some late night barn dance. My head was spinning and my partner was less than impressed with my lack of coordination. “Come on” she said. “Keep up”. Throughout the song I was thrown, spun and contorted in all directions. I was given a dance lesson as well as an amazing display of energy and vitality. When the song ended my head spun and I couldn’t comprehend what had happened. I felt like I had stepped off an amusement ride at Brighton pier. As a reward my partner gave me a cheeky pat on the backside as I sheepishly sat back down. My partner continued with her lively and rousing dancing on her own. I wasn’t good enough.

This was my introduction to music in healthcare in a setting for people living with mid to advanced stage dementia.

I was privileged to be allowed to observe five music sessions in an assessment unit for people with dementia. I was not privy to any confidential information nor did I see the patient’s outside the one-hour music session each week. This account is what I witnessed and observed.

According to the NICE report. “Group activities such as singing will prevent a decline in independence and support mental wellbeing”. [1]

The report also goes onto say that: It is unclear whether it is the singing itself, the group based activity or something else that produces the benefit”[2]

What is that something else?

During the five weeks I witnessed some of the most humane and emotional moments, too many to mention them all but some will forever stick with me. During my last few weeks I sat beside the patients and talked to them during the sessions helping them with rhythms, encouraging them with singing and generally being someone to chat to. I had a conversation with a patient who admitted that she could remember no music, could not sing and was generally nervous about the group. I gave her some percussion and allowed her to explore the instrument in her own way. There is no need to play or sing correctly, that fabulous word, “Musiking”[3]was always in my mind. The lady in question was soon requesting songs, singing what she could remember and at one point after a version of “We’ll meet again” she began to cry.

She told me about her memories of her sister who has since passed and her sisters love for the song. “Music aids reminiscences and memories which can be emotional in nature to be revisited.”[4] The inclusion of music in healthcare settings can help with Reminiscence Therapy.  Reminiscing which music can be an aid for can improve mood, wellbeing and can improve mental abilities such as memory. By talking about who they are It can focus the patient on memories and what they can do rather than what they can’t.  She shared a few stories about her sister and her obvious longing for her. Music helped with a cathartic release in a consequence free context.[5] In non-scientific terms, she felt better after a good cry.

Another incident was the final session for one lady whose husband joined her for the music session. As they sat holding hands singing Que Sera, Sera.  The inexorable meaning of the lyrics and the music said more about the situation than any essay, report or observation ever could.  The song also allowed the spritely personality of that one patient to be revealed again to her husband as they sat enjoying the group sing along in the supposed sterile environment of a ward.

It is a sensitive and difficult approach whether to play sad music in such a setting, but the human obsession with sad music will never disappear. Some of the biggest and most popular pieces are sad songs that deal with lost loves, unrequited loves and the Requiems of Classical music. These subjects and pieces will continue to remain popular and if a cathartic and positive release can be gotten from them then why not use them? The music sessions are a space to remember memories happy or sad with the musicians, nurses and OT are there to provide support when needed. Music can induce involuntary autobiographical memories which can help well-being and help with creative thoughts.[6]

Not every session had such melancholy moments. Most of the sessions were full of wonderful happy, humane moments. Every week the same patent thanked the leaders and myself for coming. She joined in with an enthusiasm that was infectious, no matter what the tune she joined adding her percussive element and creativity. For the hour each week those who attended, despite being highly individual, came together in unison through rhythm and song, they worked as a collective to encourage the sharing of old memories and to create new ones.

The repertoire was mixed and varied from war songs, classic pop tunes to obscure show tunes. Choosing a repertoire to satisfy such a group is an unenviable task and one that I thought the leaders managed with great skill and sensitivity. Each week they had a new tune to add or a song that was requested the previous week. The research and dedication to finding a tune for each patient was admirable and highly person centred the musicians have done a great job of bonding with each participant making sure to take an interest in the patient’s musical taste.

One lady who did not want to take part in the session as she only listened to classical music. Ignorantly I put this down to musical snobbery. I could not have been more wrong. To strip one of their preference of music is to take away their sense of identity already being peeled away by their stay in the hospital, their connection to life outside the hospital setting maybe defined by their love of classical music. I played in future sessions a brief snippet of Lute Suite in E major by Bach, unfortunately the lady had been discharged when I got round to playing it. With the development of music technology and apps on I-pads it is now possible for everyone to play. If only the lady had of been willing to explore the technology available to allow her to play strings or brass on the I-pad allowing her to create in the musical genre she loved.

The work carried out by the musicians crosses many boundaries form community music to music therapy. A study by psychologist Laura Mitchell[7] found that music if being used for a therapeutic reason should include the persons preferred music. “Music therapy for a heavy-metal fan should include heavy-metal.”[8]

The musicians performed the repertoire and the participants joined in rhythmically, orally, with movement or some listened. The musicians were the facilitators and spurned the session on. One instance which happened quite fortuitously was maybe my favourite moment of all.

The song being performed did not come to its natural cadence. Every participant throughout my observations recognised the cadence in every tune naturally and musically, every song ended with grace and with minimum effort from the group. For one reason or another the musician forgot to play the cadence and the rhythm kept going. For around two minutes’ the rhythm kept up, there was no defined performer, no facilitator, no structure, no restrictions. There was a great amount of eye contact between everyone and smiles when it was agreed non verbally to carry on. The room was in unison, concentrating together to carry the pulse and rhythm, everyone’s contributions could be heard, all contributions were unique, individual and valid. Without speaking everyone had found their voice and had added to a spontaneous group composition. When it came to an end it ended with satisfied silence, everyone had connected through music.

A cliché and overused quote by Victor Hugo. “Music expresses that which cannot be put into words and that which cannot remain silent.” Perhaps this unspoken communication is the something else? Music is part of our lives from birth to death. Throughout life we create our own personal soundtrack, we imprint music with our own personal journeys. Music is not only inside us all, Music has the power to reflect who we are and music defines us.

Perhaps that something else is the humane and inclusive moments, the sharing of memories and the connection and bond you feel and create with others as you partake in a musical activity.

 

Introducing our 10 trainee Musicians in Healthcare!

It’s the end of our Music in Healthcare training course in East Sussex! We have had the privilege of working with these 10 talented musicians who have spent 5 days with us, learning and experiencing first hand how they can use their skills to bring interactive music making to the bedsides of children in hospital.

Our Foundation Training combines creative music making and exploration of how music can help support children in hospital with on site visits to the Royal Alexandra Children’s Hospital in Brighton where trainees take part in musical interactions. Its been an amazing journey !  Our thanks to all who took part, to East Sussex Music for supporting the course and as always, to the children, staff and families at The Royal Alexandra Children’s Hospital in Brighton for making music with us.20160406_131147

Music in Healthcare Foundation Training course in March 2016

wishing well musicians

Music in Healthcare, Foundation Training course to be held in Sussex, 31st March to 6th April 2016.

Our 5 day Foundation Training course combines theoretical learning with practical music making and on site visits to The Royal Alexandra Children’s Hospital in Brighton.

This is a fantastic opportunity to explore live, interactive music making in hospitals and other healthcare settings for children and young people. The course will introduce you to the thinking behind using music to enhance wellbeing and to enrich the sound ecology of clinical spaces.

The deadline for applications is Friday, January 22nd 2016.

Download the information sheet here [PDF]

Download the application form here [ODT] or [PDF]

Rhys and The Royal Alex on BBC South East

Thank you to BBC South East Today and BBC Children in Need for choosing our Wishing Well Music in Healthcare programme to highlight on the news. We are thrilled to be supported by Pudsey Bear so that we can continue to bring music to sick children at the Royal Alexandra Children’s Hospital. Thanks to the wonderful children, families, doctors and nurses of the High Dependency Unit for being a part of the film.

“And so the music plays” A new blog by Lucy Frost

“And so the music plays” A new blog by Lucy Frost, Dementia Specialist Nurse and Wishing Well music champion

Several months ago we arranged screenings of the documentary film Alive Inside to NHS and social care colleagues, as well as members of the public.  The aim was to use the messages about the potential power of music in making a connection with a person living with an advancing dementia.  We hoped this would help health professionals think about how to use music in the care settings in which they were based to help start interactions with people they were supporting.  We hoped that people working in the dementia care field would meet other interested colleagues, get talking to members of the public who came, and share experiences and ideas.

I know, from working alongside people with dementia and their carers as I do, that music can be emotional.  However, reconnecting with these emotions triggered by hearing a favourite song or piece of music is indeed so powerful it can actually bring someone back to reconnecting with who they are.

Over 500 people attended the screenings, and we received hundreds of ‘pledges’ from people letting us know what they might do to bring more music into the lives of people living with dementia.  This included a local care home investing in personal music players for residents, and a local community choir going into local care homes to sing with people (Note the sing with / not for)  This was all about music with people with dementia, and making it personal.

At around the same time, Wishing Well Music in Healthcare, a local progranme delivered by Rhythmix music charity had begun to work with people with dementia in hospital.  This project was supported by the Dementia Care Team at the hospital, and had a small amount of funding.

I met with Jo White from Wishing Well, and quickly came to the realisation I had to do whatever I could to support this project, and make it count.  Hospital can be a difficult place for a person with dementia, and this was something that could lighten the mood, and change the space.

We were so moved by the impact the sessions have had on the people who have been involved, people living with dementia and those caring for them, we decided to make a film about it!  Sarah West , a local Brighton based film maker agreed to help us, and the people you see in the film were very generous in allowing their experiences to be shared.  Go to our “Film” tab to see the result!

Projects like these can only be continued where there is funding to support them, and the sad fact is there is just not enough music playing in the lives of people with dementia, particularly those people who can no longer always rely on spoken words.

The impact of music seems to be such that it enhances wellbeing.  Music as a recognised intervention for communicating with a person with dementia, is an area that requires ongoing research and evaluation.  It may then become clear how using music in the right way helps make better outcomes for people.  As the evidence base grows, so does the case for bringing music into hospitals and care homes routinely.

No one should be denied the opportunity to  reconnect with their own personal playlist, which is the soundtrack to our feelings and memories – The Wishing Well Project can do much more with the right support to make it happen.