Juliette Keelan, CMP at Emory Healthcare has two quotes on the back of her business card.
“Music heals.” — Pythagoras
“Music is the principle that unites body, soul, and spirit.” —Boethius
Many of you have seen first hand the results of LTM (Live Therapeutic Music) in patients, but did you realize that the LTM was also benefiting you?
First though, a little explanation for better understanding.
Janie Woods Alexander, MSN, RN, CMP, Therapeutic Musician at Emory Healthcare and Instructor of Music for Healing and Transition Program points out that the difference between CMPs, TMs, and MTs is often misunderstood.
She says, “We (CMPs) are called music practitioners or therapeutic musicians (TMs). We are not music therapists (MTs). TM’s and MT’s can and do work side-by-side using music/voice but with a totally different set of goals and scopes of practice.”
The difference she says is that MTs are prepared with a college degree and are focused on goals of cure and rehab of patients. MTs have specific goals which most often involve active participation by the patient in the music. For example, an MT might be used to help a stroke victim learn to walk or talk again.
CMPs or TMs complete a rigorous certification program from a Music for Healing and Transition Program (MHTP). The course is 80 hours plus a 45 hour internship.
CMPs use live acoustic (never recorded, digitalized, compressed or amplified as in CDs ) therapeutic music/voice at the bedside to create a calm, relaxing environment in which people can feel a sense of safety and wholeness.
There is solid science behind therapeutic music. TM is based in the physics of sound and vibration and in the growing body of knowledge of neurophysiology.
Neurophysiology explores how the body processes and responds to the presence of direct vibrations from an instrument, as well as the vocal chords.
Alexander explains, “The body receives the direct vibrations through the skin, skeleton, nervous system and ears, and the brain is activated to interpret those vibrations as what we humans call music.”
She says, “This environment often leads to decreased anxiety, less muscle tension and more relaxation, more rest and sleep, all of which are conducive to the body and mind healing. In the case of pain, thresholds can be raised by relaxation of muscle tension.”
She adds, “Vital signs, often unstable due to activation of the sympathetic nervous system (fight or flight … after surgery, in trauma, during procedures, during birth) can stabilize in the presence of LTM, which speaks to the opposite system; parasympathetic (including the vagus nerve) which is responsible for relaxation and return to a relative state of homeostasis.”
“TM’s (CMP’s) are not performers. Their presence at the bedside is a companioning of the patient, whether the patient is being born, acutely ill, recovering joyfully from illness, surgery or trauma, or at the end of life. The focus is on the patient, not on the musician/singer. Music is chosen and adapted to the individual needs of the patient in the moment and can be changed at any time to meet the evolving needs of the patient. The actual, visible presence of the TM, for patients who can see, is an added benefit of the companioning with LTM.”
Finally, says Alexander, “The music played by a TM (CMP) at the bedside is diverse including ALL categories familiar or unfamiliar; classical, folk, rock, lullabies, jazz, oldies, blues, early music, chants, and improvisation. We can gladly play/sing religious music but only by request by the patient. Our music/voice may range from ethereal and contemplative to poignant to romantic to funny, depending on the patient’s needs. Patients will sometime smile, laugh or have a needed release of tears in response to the TM. Falling asleep is also one of our most common patient responses.”
In her rounds at the hospital, Keelan says that she sees a number of positive responses. Not just in patients (and their families) but also in the staff.
She says, “I see an almost reset-like reaction that overcomes the staff, as a calmness and re-focus shows through to me, both during the LTM, and as the visit is finished. To me, it seems like the staff is given a chance to have care for themselves, too, that will assist them as they move forward with their continued care for others.”
“Many staff members, including administration, doctors, nurses, physical therapists, occupational therapists, nutritionists, social workers, janitorial services, etc., stop me as I’m passing them, and express their gratitude, and have given comments like, ‘Oh, so glad that it’s music-day!’ ‘Boy, we needed this (LTM) today!’”
She also notes, “The faces of the staff who are present during LTM, have what seems like a rejuvenation look, the results of what I like to call an instant Music-Massage! A spontaneous blooming-like, new energy (a quiet, peaceful energy) also seems to unveil with the staff, after and during the visit of a Therapeutic Musician.”
Alexander adds, “Staff often visibly relaxes (shoulders drop, steps slow down and are more deliberate) and they often report minds clearing as they have LTM in their work environment. We TM’s have been known to be asked to stay to play during an emergency CODE to support all involved from patient to family to staff. Sometimes a staff member will request a ‘dose’ of direct one-to-one LTM. LTM is also offered in surprising places … shock-trauma areas of some major medical centers, such as Johns Hopkins and all the ER’s at EHC.”
According to Alexander, another area being examined for effective use of LTM is with compassion fatigue and stamina of staff. She says the Chaplain department at EHC is currently actively addressing this with nursing at all EHC’s multiple hospitals.
She says, “The use of LTM to enhance meditative practices is being invited and encouraged for staff support. My favorite saying goes back the dark ages of nursing when I started in 1965 and all nurses were women … “Mama ain’t happy ain’t nobody happy” adapted now as “Our nurses ain’t happy, ain’t nobody happy” because these days, thank heaven, the guys have joined us in nursing!”
If you haven’t worked in a setting where LTM is utilized, Keelan shares some stories from her rounds that represent the myriad benefits to having LTM in a healing environment.
While many people associate LTM with adults or those in palliative care, patients of all ages benefit from the practice. This is what happened on one of Keelan’s visits to the NICU.
“Within the first 10-15 minutes of playing LTM for a neo-natal unit preemie, the staff supervisor present, excitedly told me that the monitors showed an elevation in the oxygen saturation of the infant. Also, I observed other babies close by to where I was playing music, went from restless, to a return to resting and sleeping.”
Keelan also shares another great story from the Cancer-Care Unit.
“A gentleman approached me as I finished playing LTM for another patient close to the room where his mother was. First, the man thanked me, and said that his mother was crying and very upset, and she heard the LTM being played close by, and for the first time that day, she was calm, and even looked happy! He informed me that his mother was to receive her last chemo-treatment and she was being moved to hospice care.”
“While playing LTM for this lady, she couldn’t stop smiling, and thanking me for being with her. The son asked if I could play a particular song. I informed him that I wasn’t familiar with that tune, but I would be glad to hum along with him. We did just that, and we were both thrilled to see that the patient began to sing the song with us! Her hands released from closed and clenched to relaxed and swaying with the song. A huge thanks for the LTM, from the patient, from the son, from the patient’s nurse, from hospice care personnel, and from the staff close by, who said that at the same time that I was with this patient, they were receiving some benefits from the music, too.”
Of her experience as a CMP, Keelan says, “I feel that it really does take the whole healthcare team to get the best care for the patients at EHC, and, our contributions as CMP’s bringing live therapeutic music to Emory Healthcare Facilities, as a form of complementary care, hopefully will help create a healing environment for the patients. Also I hope it will help the staff, as they give their best care for the patients at Emory Healthcare.”
