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Healthcare | Complementary Therapy is an Art

Hospitals find music and other artforms improve patient outcomes, lower stress for all

By wmadministrator

The music therapy team at Norton Healthcare are from left, Alex Ruffner, Brett Northrup, Kerry Willis, Kyle Hubert, Melanie Brison, Brian Schreck and Jenny Branson (seated).
The music therapy team at Norton Healthcare are from left, Alex Ruffner, Brett Northrup, Kerry Willis, Kyle Hubert, Melanie Brison, Brian Schreck and Jenny Branson (seated).

Board-certified music therapist and University of Kentucky Arts in Healthcare clinical coordinator Cheryl Benze was once called into a dying patient’s room in the intensive care unit by the family who wanted her to play their loved one’s favorite song, “His Eye is on the Sparrow.”

“She was mentally responsive, but her heart rate was so low,” Benze recalled. “She sat straight up in bed and sang the chorus and laid down and sighed, and then the monitor went flat.”

Another time, she was in the room of an Alzheimer’s patient who was admitted for a cardiac event and was unresponsive. All five of her daughters were in the room – distraught because they felt they did not have the time to say goodbye to their mother and didn’t know if she was hearing them speak to her.

“I asked if there was a song she liked,” Benze said. “They asked for ‘In The Garden,’ and the patient was facing her family when I started playing, facing away from me. I started singing, and she turned and faced me. The family realized she was hearing the music and realized she was hearing them tell her they loved her.”

Stories like these from Benze at UK Albert B. Chandler Hospital and more from Jenny Branson, a board-certified music therapist at Norton Audubon Hospital in Louisville, are notable and generate support for both music and art therapy. These “complementary therapies” are fairly new in the world of medicine, but are gaining major traction as means to reduce stress, ease pain and help patients and families deal with hospital stays. They also help hospital staff and doctors cope with stress.

Visual art installations were incorporated into the state-of-the-art design of the 10-story UK Hospital, which opened in 2010, and includes an auditorium through which performance can be piped into every patient room.

Baptist Health Lexington Cancer Center recently installed major works by renowned Kentucky glass artists Stephen Rolfe Powell and Brook Forrest White Jr.

Branson was hired 13 years ago at first as a consultant at Norton and now serves as the program builder for all of the music and art therapies.

“I was originally hired to do a pilot project to demonstrate the impact music had on pain for post-operative open-heart surgery patients,” she said. “A really important objective in the first few year was educating other clinical staff about music therapy. It was about year three that we saw it take off. We became so busy with referrals that we couldn’t see everyone.

“The nurses used great critical thinking and realized they could use this for more than just pain. We have an open referral model, so we don’t need a doctor’s referrals. Nurses can advocate for what their patients need.”

Branson said music and art can be used for easing anything from social isolation, stress of long stays, post-operative pain, chronic pain, end-of-life peace, helping with orientation, emotional stability, confusion, regulation of breathing and more.

“The patient has the right to refuse, which is a very powerful thing because there are few things they can refuse,” she noted. “Intervention can last 15 minutes up to two hours, depending on what we’re trying to address. We document it in electronic medical records just like other clinicians.”

Eight music therapists work for Norton Healthcare. The minimum requirement is a bachelor’s degree in music therapy and then a national board certification. Treatment can mean simply providing calming music, structuring an environment, managing drug withdrawal, or getting a patient to breath more rhythmically. The objective is always to engage them at the highest level possible, which many times involves active music making.

“Maybe the patient has a goal of increasing activity, maybe they need to get in a chair and stay there for a certain amount of time,” Branson said. “When working with younger or more active populations, we will compose music and record it. One therapist, his area of interest is specifically pediatric end-of-life care, so he creates compositions using recordings of the patient’s heartbeat. It’s the pulse of the music and is a memory-making or legacy-making opportunity.”

Music therapy is used for all ages, even in the neonatal intensive care unit (NICU).

“Across the spectrum, it’s great for reducing anxiety, agitation and pain,” Branson said. “It engages folks. It’s social, which is important for humans. Kids and families in the hospital for a long period of time, they need to do something normal.”

She continued, “We’ve documented at Audubon that we can reliably reduce pain by 50 percent. And we have a good track record for helping patients who are anxious on ventilators come off of them sooner. And for managing addiction: Music triggers the same reward center in the brain as drugs. It’s not the same strength, but it can empower them.”

Branson feels that musical beats are so powerful in therapy because “we’re made of the pulse, and that is the first sound that we hear, the first thing that we know as humans, so we’re always looking for something that’s regular and that has a pattern.”

For Norton patient Jan Deleuil, 68, music therapy was the difference between life or death in coping with COPD. She’s long surpassed her initial prognosis.

“In 2007 I was rushed to the hospital with COPD, which I didn’t know I had,” she said. “When I first met Jenny (Branson) I didn’t remember anything about it. They had me on a (heart-lung) bypass machine and I was not doing well. I was fighting it, crying, screaming. They called her in and she came down for two-and-a-half hours and was with me, and I didn’t even know it. She finally calmed me down.”

During her first three hospital admissions she utilized music therapy, but the fourth time she was very depressed and frustrated.

“Jenny came in and had an ocean drum,” Deleuil recalled. “She taught me how to play it, so I’m lying in the bed playing it, and I started pounding on it with all of this anger I had inside because I had this disease. I just took it out on that drum, and she let me. Then I started crying, and I felt so much better.”

Ten years later Deleuil, who was new to playing music and previously could hardly breathe, now sings in a choir at the hospital and participates in regular outpatient music groups. She’s made friends, her lungs are stronger and she seldom has to use her (supplemental) oxygen.

Though the comprehensive results are hard to quantify, patient outcomes are speaking for themselves.

“I think that music therapy is now to a point where we have enough decent research behind us to have a business rationale for implementing it,” Branson said. “It’s an inexpensive department to run. We don’t have a lot of supplies or expensive equipment, and the outcomes and patient experience can be huge.”

Vice President of Operations and Finance at Norton Audubon Hospital Jonathan Presser said the administration sees alternative or complementary therapies as enhancing the patient experience while also helping patients and families cope with an illness or hospitalization.

“Music therapy in particular was originally funded (in 2002-2003) through a grant from the Norton Healthcare Foundation and several generous donors who are passionate about the service,” he said. “Then around 2007, the decision was made across all of Norton Healthcare to employ music therapists instead of having these professionals as vendors. Over the course of the next several years, each facility began employing its own music therapist(s). To date Norton Healthcare employs eight music therapists.”

They work with inpatient, outpatient and families at five adult hospitals and one pediatric hospital. He said the organization does not track a cost impact on average length of stay, reduction in drug expense, or other information on patients who specifically use music therapy.  

“Although it is not measured, I do see the value of these services when our patients use them,” Presser said. “Overall, these complementary therapies have been proven to impact pain levels, help patients psychologically with an illness or hospitalization, aid in physical therapy and lower anxiety levels for an upcoming surgery. We also utilize these therapies in helping reduce stress in our staff. All of these can have a ‘soft’ impact on patients and employees. We are very fortunate to have the financial support of the Norton Healthcare Foundation to help us fund additional arts programs such as traveling art pieces displayed in the Robert Lerman Memorial Music Library and hosting local musicians to perform for patients, families and staff.”

Benze, who serves as the art and music therapy clinical coordinator at UK, manages a staff of nine total part-time and full-time music and art therapists and interns. She said the hospital needs more. The program was originally funded by a former patient’s foundation, and now the school has an academic program. Therapists also regularly work with physical, occupational and other therapies.

“Music therapy is generally more broadly applied, which is why we have more music therapists,” Benze said. “With art therapy you have to be able to participate and do the art. The finished product is not the important part, but it’s the practice.”

She explained that art therapy has always been more about “psychotherapeutic intervention,” where the interpretation of the art is the therapy. Benze pointed out samples in her office of art books about gratitude and pictures that display different types of emotion. A current goal is to get a full-time art therapist devoted to Kentucky Children’s Hospital.

“Medical art therapists often work with cancer patients, dealing with a lot of pain, anxiety, expressing feelings, coping skills, coming to terms with a cancer diagnosis,” she said.

She said art and music therapists sometimes work with caretakers – like neonatal intensive care unit(NICU) nurses – who are under immense amounts of stress. They even teach frantic NICU parents how to sing calming lullabies to their babies, whom they often are not able to hold.

Benze said the success of these programs indicates that UK Healthcare is very open to nontraditional therapies. She said there are other practices around the hospital, whether it’s yoga class or aromatherapy, that signal the hospital is willing to explore options that oftentimes are much less costly and invasive.

Music can bring people off of medications faster, help them learn to walk again, move their heads side-to-side, and regain cognitive function. The complementary therapies can be given in conjunction with other traditional therapies like anesthesia, but it also can be used as a replacement.

Art installations throughout the hospitals create a welcome atmosphere. Both UK and Norton have regular installations and walls that are set up like actual art galleries for rotating installations.

“The art has been very meaningful,” Benze said. “We’ve had people who had no other way of expressing themselves who felt that the art just came out of them. There is a need in humans for expression and creation of art.”

The practice will continue to grow if people like Benze and Branson are involved.

“A lot of research is happening in our field across settings, and as music therapists are learning more about conducting randomized controlled trials and getting the data we need, it’s improving,” she said. “It’s challenging because there aren’t that many of us, and most of us love to be doing clinicals and don’t want to focus on the research aspect of it.”

She noted that hospitals are becoming much more “consumer driven” and that have “people have more choices and different expectations about how they’ll be managed.”

Abby Laub is a correspondent  for The Lane Report. She can be reached at [email protected].