Progress report – Gloucester Hospital Neonatal Music

Thought I’d write an update on how the music is doing in the Neonatal unit at Gloucester Hospital in the UK, in case any of it might be applicable / useful to anyone else doing this anywhere else.

We started this project with an idea to play harp music to babies, and once we got a positive reaction from the hospital and some external funders, quickly progressed to reading about 50 current papers covering the effects of music on prenatal infants, the effects on musicians of delivery of music in a hospital, and the effects / expectations of music by staff and carers. In addition, I met and worked with 7 other musicians at Derby Royal Infirmary children’s hospital, including in neonatal, A&E and in recovery wards, so between the initail go-ahead and when we started, I’d amassed a fair bit of theoretical experience on aspects such as medical / musical ethics as well as practical experience on how music is offered and received in a way that allows patient choice.

I have also been researching a considerable amount about collaborative music and the effect of music on children and have seen some fairly flaky books so it’s important to go to peer-reviewed papers. The upshot of much of the research is that there is a huge spread of variables to do with premature babies which makes it difficult to draw clinically statistically valid conclusions, and one of the ground-breaking aspects of our programme was to look at the relationship between mothers and babies rather than treating the baby as a “subject”, in isolation; we are also looking at qualitative, not quantitative, data (although see later about this, because we always felt the music was a huge opportunity for the hospital and have pushed this a bit with the consultants).

The project aims to:

  • introduce live harp music to help mothers and babies bond (where mother and baby are both present together)
  • create recorded music that’s available for people to take home / access online and
  • extend the music into baby groups for parents who have left hospital and whose babies still have special needs

It’s been about 8 visits now and the whole environment is starting to feel very familiar. The main changes for me are that I tend to come in and get playing quite quickly (always starting by playing to one of the babies which doesn’t have an attached parent first, so others can make an informed choice about whether they want the music or not). I hope I have the right mix of businesslike and caring! And you’ll probably think this is strange, but I always say hello and goodbye to the babies before / after playing, when their parents aren’t there. Just seems so right. I’ve noticed, too, that if parents are there, they often move in to be near / stroke their babies’ heads while I’m playing, and I absolutely look at the babies or my hands, rather than intrude on what I think is a precious moment for the parents and children. Very conscious of that – where I look, where I sit, how I offer and withdraw, not that that’s easy to describe! I’ve noticed people quite often take their babies out to hold them and listen, if they can, but that’s not easy for either the mother (not always easy to move!) or the baby (connected to monitors).

To advertise the visits I create a poster for each pair of dates which are very simple and advertise the time of the next visits. I email pdfs and the nurses put them up. I deliberately wanted them to make the effort to print and put them up so they have a stake in this and that’s working really well. There’s a huge awareness and anticipation around our visits and the staff stop us in the corridors to say how much they are enjoying the music. There’s also a QR code which allows those with smartphones to access a page including some music, so they can listen anytime.

I’ve had quite a few parents who have really been keen to share comments on the effect of the music, and also photos, with permissions to use them anywhere. They are hugely supportive of music and the effect it has. We also had a photographer commissioned by the hospital press office, who took some lovely shots and I pestered the press office to let me use these and they gave me full permission to use in any way I wished (wasn’t expecting that, as they paid for it!).

We are also starting to have conversations with parents who are leaving the hospital, who have heard the music on quite a few visits, and would like to be able to play the music to their babies at home. We will have a CD available of the music I’ve been using, but not yet. However, we will put the music online and also continue to meet those parents later down the line at special baby groups, so it’s a great opportunity to continue that relationship.

So that’s all positive. We have honestly had very few negatives – the only one I can think of is one couple who didn’t want me to play, and I always try to remember that no-one is in a neonatal unit because they want to be – people are going through some very testing stuff emotionally and in their relationships. That’s where it’s really important to maintain the sense that what you’re doing is an offer and not to expect anything at all out of it.

The other thing that’s changing is that the hospital nurses and consultants are starting to take an active interest rather than merely offering support. The consultants are talking about getting together to look at whether / what data that they can gather to demonstrate the effectiveness of the music – we have qualitative data (positive comments from parents / staff / consultants, plus occasional observations by my researcher colleague) and are leaving it at that. So while the music approach was hugely informed by our reading of the available research, it is right that they might wish to investigate this matter themselves, perhaps to see if a Return-on-Investment case can be made for music. This has been helped by sharing our approach with all at the hospital, but also in having a named consultant and nurse as the
points of contact for the project, and keeping them across it all. So we’ve pushed it a bit, but actually now the impetus is coming from them, and that’s a hugely positive sign. Clearly there’s a critical mass of anecdotal evidence and they now wish to take it further.

For feedback, we have a comment book on the nurses’ station and it’s always been highly visible. Anyone – parents, nurses, consultants, visitors, can write in it, and I take photos of the pages as they are filled in, which makes data-gathering very easy (I use my ipod). I write in it too, after each visit, and sometimes people answer back! So we have conversations through the book which gives a lot of continuity but also shows who is taking an interest. Lately this has prompted two new developments which I am just embarking on.

  • I wrote in the book that I had avoided the Intensive Care room as there was a procedure going on, and one of the nurses picked up on this and asked if I might be willing to play for procedures. So I’ve done the first playing during 90 mins of procedures, to accompany Retinal imaging on each baby, which is a fairly distressing procedure for them and have offered that at any time I’m in the wards, I’m happy to be called over for any other procedures. The retinal one was quite intersting as one baby slept through almost all of it – so much so that the nurse was asked if that was unusual, and she told me “that’s the first time I’ve not heard a baby cry in 12 weeks of doing these procedures. Yes, really unusual. This sits well with the funding, which is strictly speaking for babies rather than parents, and I can play for other babies / parents in between the procedures.
  • I also asked in the book about the best times of day to play (we’d already scheduled a mix and some are definitely better than others) and a night shift leader thought it might work well as the unit settles down late at night, so I’m going to start doing those next week.

Any original music I create is recorded on my iPod as I play, so I can then remake it at home (with the right tempo, as performed in the hospital). I’ve now built up quite a bank of these recordings ready for our CD to be made later in the year.

This project is leaving me with a profound respect for the parents and all who work there, and also an awareness of how the medical “machine” bit of a hospital doesn’t really cater to people’s spiritual needs (for art / connection), especially understandably in the case of Neonatal where the adult “users” aren’t actually being treated because they’re not the patients. So it’s becoming a privilege to get to know better individual babies, parents and nurses / consultants. Hope that’s all interesting – it’s felt like a really gentle process but a really worthwhile one.

2 thoughts on “Progress report – Gloucester Hospital Neonatal Music

  1. Hullo Mark, As a therapeutic harpist I had the experience of playing in a special nursery yesterday in a Sydney hospital, very different to playing in Palliative Care units, chemo suites or day surgery. One of the comments I received yesterday was that the NUM would like to see papers on the effectiveness of harp,therapy with premmie and sick children, and that’s how I happened to come upon your marvellous website, and this morning your update. Fascinating and so helpful because now the hospital is looking to give me a grant but of course they would like to have documentary evidence as well as comments from families and staff. Did you come across your papers after searching the Internet? I hope your work continues to grow from strength to strength and that more and more of the consultants and staff will realize the efficacy of live harp music with such young patients. Regards Anita

    1. Just for anyone else reading, this is the reply I sent Anita:

      I got my papers from various sources, some from the authors, but on condition that I didn’t share them further. But yes, basically after searching. Neonatal is an interesting area because there are so many different conditions / histories / environmental factors that it’s very difficult to look at progress in any way that’s statistically reliable. For example, very difficult to have a control group which is going to be close enough to the group being tested, and yet also consistent and reliable as a control. Therefore my memory is that most studies conclude that there isn’t sufficient information. There are some “studies of studies” which pull together many papers, but can’t put my hands on them right now. However, I’ve attached one of the papers I had so you get a feel for it.

      In my own programme the hospital were very willing to allow me to experiment, and I ended up playing for procedures etc. It’s difficult to disentangle the effect on the babies from the effect on the adults (ie parent/carer, visitor, medical staff, even the cleaners and others who also visit the areas) and that was fine for my programme, because I figured the babies were the subject of enough attention and I wanted to do something to help the relationships between babies and their parents (principally). Actually we were offered randomised data but decided we wouldn’t know what to do with it if we had it.

      I did interview parents and staff after the project, but clearly there’s also an observable effect (otherwise I wouldn’t have been asked to play for procedures – and have had babies fall asleep during procedures they otherwise dislike, such as retinopathy). In addition, music is one of the few artistic enhancements you can bring into an area that doesn’t compromise infection control.

      I don’t know if you saw it but I created a page for parents at http://www.musicgarden.co.uk/harp which I used to introduce the parents to the idea of music (and to allow them to hear the tunes as they emerged). But I also did some experiments of my own – for example, hearing what the harp sounds like outside and from inside an empty incubator, at http://www.musicgarden.co.uk/incubator.

      I know none of this really answers your question about documentary evidence (or maybe it does) but I do have the report I wrote, which includes interviews. I don’t have that to hand but I should be able to get that to you if it helps. You might also like to contact http://opusmusic.org/ who are the ones who helped me hugely on my journey – although I actually started my learning by looking at papers (as I had to start somewhere) and then did the practical work. My experience was that I did my best work after I realised the babies were in the best possible care and I could get on with being the best musician I could be. Obvious really but it took me a while to get to that point! The evaluator also observed that my value was not just in playing music, but in using that as a way in to having conversations with parents after playing.

      Finally the work encompassed all times of day but generally avoiding rounds and visiting times. I even got invited to play around 11 / midnight at night, which was rather cool. I was always welcomed and (a bit of non-clinical evidence) when prospective parents were being shown around the wards they very proudly introduced me as “the harpist”. I didn’t see it but of course for them, it was a bit of an asset to have something so unusual going on. At the very least it gave everyone a breath of outside normality in an otherwise pretty sterile environment.

      PS, and again probably not clinical evidence as such, but I’ve kept in touch with many of the parents and played for one of the babies’ christenings the other week, and also was there at the launch of a support group for parents, so clearly the music is seen as something that adds to the experience of neonatal in a positive way

      Hope that helps but if there’s something more specific I can answer please do let me know!

      Mark

Leave a Reply

Your email address will not be published. Required fields are marked *