American College of Physicians: Internal Medicine — Doctors for Adults ®

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The healing arts

Music and art offered to hospitalized patients

From the February ACP Hospitalist, copyright © 2012 by the American College of Physicians

By Stacey Butterfield

When patients in the cardiac surgical unit at Mayo Clinic in Rochester, Minn., complained of pain, clinicians initially responded by trying to optimize their medications. But that didn't fix the whole problem.

“Even with bringing in a variety of medications, patients were still complaining of pain,” said Susanne M. Cutshall, MS, RN, an integrative health specialist in the department of surgery.

Music therapist Lorrie Kubicek works with a patien...

Music therapist Lorrie Kubicek works with a patient at Massachusetts General Hospital Cancer Center in Boston. Photo courtesy of Steven Gardner.



Ms. Cutshall and colleagues investigated the patients' complaints and found that the problem wasn't always a direct result of their current illnesses and treatments. “It was back, neck and shoulder pain. If you talked to them a little bit more, it was really about the whole experience—the anxiety, the stress, how they are positioned—that contributed,” said Ms. Cutshall.

To treat this unexpected problem, the Mayo team tried an unusual solution: music. In a trial published in the July/August 2011 Alternative Therapies, postoperative patients were randomly assigned to 20-minute periods of either quiet or classical music that incorporated nature sounds, twice daily for three days after surgery.

Patients who listened to the music had lower pain scores at the end of postoperative day two. “We didn't necessarily see a huge reduction in pain, but I think anything we can add in can help them ease pain and tension and improve the overall care experience,” said Ms. Cutshall.

Not just music

Mayo is not unique in looking to ease pain, tension and other negative effects of inpatient stays, and other hospitals are also incorporating the arts into this effort. Programs range from efforts as simple as putting CD players in rooms to having certified art and music therapists work through goal-directed programs with patients over the course of their hospitalizations.

“There's a growing body of evidence,” said Theresa McDonnell, NP, nurse director of clinical practices at Massachusetts General Hospital Cancer Center in Boston. “Art is yet another modality that you can utilize to reduce stress, reduce anxiety and help the patient cope.”

Arts therapist Michele Heidel with a patient at Ma...

Arts therapist Michele Heidel with a patient at Mayo Clinic. Photo courtesy of Mayo Clinic.



Recent research has found that programs incorporating art therapy (which has traditionally been used mostly with pediatric and psychiatric patients) reduced pain and fatigue for adult cancer patients. Music therapy, a more heavily researched field, has shown effectiveness in treating pain, anxiety and even stroke damage.

Kimberly Donley sees the benefits for stroke patients in her work as a music therapist at Abbott Northwestern Hospital in Minneapolis. “If a stroke patient has aphasia, depending on where the stroke has occurred in the brain, they may be able to still sing,” she said. Using songs familiar to patients, Ms. Donley gets them started verbally communicating again.

“The look on some people's faces when they suddenly hear the words coming out of their mouths when they've not been able to talk for days is just extraordinary,” she said.

Musical instruments, such as small harps, can also be used in patients' recovery. “Sometimes I'll have them use their good hand to hold the pick and have them put their weaker hand on the pick as well. We're increasing the range of motion in the weaker arm,” said Ms. Donley.

Playing instruments can be therapeutic even for patients who don't have functional limitations, noted Lorrie Kubicek, a music therapist at Mass General. She works with cancer patients and offers them options from keyboards and guitars to a computer tablet application that simulates cello playing, with a variety of goals. “It could be emotional issues—depression, loneliness, need new coping skills....My job is to help patients access the therapeutic aspects of music through individualized, success-oriented treatment options,” Ms. Kubicek said.

Tangible effects

Music therapy has not yet become a standard offering at hospitals, but the arts are often being used to help patients in other ways. “It's not goal-directed, it's not doctor-ordered like music therapy, but there's still benefit,” said Christina Ufer, a music therapist working at Mayo.

At some facilities, patients can borrow (or bring their own) soothing music to listen to during their stay. Having music available can be particularly helpful perioperatively. “When going into the operating room, the calmer they are, often the less medication they need,” Ms. Donley said. “Then they wake up to the music. They wake up to a calmer environment.”

At Mayo, patients can also have calming artwork of their choice on the walls. Volunteers roam the halls with a cart carrying art that can be hung in patient rooms. And professionals as well as volunteers contribute to these programs: Musicians visit Mayo on a regular basis, and twice a week professional art educators work one-on-one with hematology and oncology patients.

“When patients are offered the opportunity to use a watercolor brush, or clay, they usually begin with the belief that they won't be able to create anything worthwhile. But they always surprise themselves,” said Johanna Rian, coordinator of Mayo's Center for Humanities in Medicine. “One patient wrote to say that she was looking forward to additional sessions with the artist during her next hospitalization.”

Finding funding

While patient interest isn't usually a problem, the typical obstacle that hospital arts programs run into is funding. Almost all of the programs rely on philanthropy, although some hospitals, such as Abbott Northwestern, have decided that the programs provide sufficient value that they are willing to pay for them. “This year or next year the hospital is taking on the full cost,” said Ms. Donley. “These services aren't covered by insurance.”

The arts also aren't necessarily covered in physicians' or other clinicians' education and training, but they are often the main source of referrals for therapists. “We get referrals from nurses, doctors, therapists, chaplains,” said Ms. Donley.

Part of many therapists' jobs includes educating their colleagues about what they do. Ms. Donley described how passersby have responded to the cart full of instruments with which she travels. “They'll see me and say, ‘Oh, are you the entertainment committee?’ It just means I need to do more education.”

Educational efforts can pay off dramatically, according to Joanne Loewy, director of The Louis Armstrong Center for Music & Medicine at Beth Israel Medical Center in New York. “When I first came to Beth Israel, I found myself trying to help doctors and nurses understand what we do so we could get referrals or even get in the door. Now the doctors are putting funding in our pot so we can come to the unit,” she said.

Physicians don't typically have much direct contact with music therapists and other providers of arts in the hospital, but everyone shares the same end goals, noted Ms. Donley. “I chart in the medical record, so I'm always very clear about goals and what we're working on,” she said.

The clinicians can also share in the successes of the programs. Ms. Kubicek works with Alzheimer's patients, who, like those recovering from a stroke, can benefit from the mental stimulation of singing songs learned in childhood.

“They have that moment in time when they don't feel confused,” she said. “The staff can see them having moments of joy, and I think that's not only good for the patient, but it's really good for the staff as well.”

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