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Ullsten, A., Söderström Gaden, T. & Mangersnes, J. (2019). Development of family-centred care informing Nordic neonatal music therapy. In: Lars Ole Bonde, Kjersti Johansson (Ed.), Music in paediatric hospitals – Nordic perspectives: (pp. 1-25). Oslo: CREMAH, Norwegian Academy of Music
Open this publication in new window or tab >>Development of family-centred care informing Nordic neonatal music therapy
2019 (English)In: Music in paediatric hospitals – Nordic perspectives / [ed] Lars Ole Bonde, Kjersti Johansson, Oslo: CREMAH, Norwegian Academy of Music , 2019, p. 1-25Chapter in book (Refereed)
Abstract [en]

Since the 1990s, the concept of family-centred care, where the family and healthcare staff share responsibility for the infant’s hospital care, has been part of an ongoing paradigm shift in neonatal care globally. The public health care system with family-friendly parental leave policies might be one of the reasons that the Nordic countries today are at the forefront of welcoming and including parents and partners in the care of their infant round the clock. When implementing neonatal music therapy (NICU MT) in the context of Nordic health care, music therapy models of practice as well as research ought to be defined and shaped by the family-centred care model, which today is considered best practice. The Nordic context also offers favourable conditions for further developing NICU MT approaches in line with family-centred care. NICU MT was first developed in the USA in the 1980s and the interventions were infantfocused, emphasising the infant’s physical and medical needs, which was the existing care focus in neonatal care at that time. Neonatal music therapy and research in the Nordic countries is still in its infancy. Systematic implementation work was first initiated in Karlstad, Sweden in 2010 and in Akershus and Oslo, Norway in 2017. 

This essay provides the international music therapy field as well as other professionals in paediatric and neonatal health care an insight into the evolving Nordic approach of NICU MT. The conclusion of this essay is that the familycentred care approach in the Nordic NICUs, combined with the progressive family politics in the Nordic countries with generous parental leave schemes and gender equality in childcare, afford important prerequisites to further develop NICU MT as a truly family-centred approach.

Place, publisher, year, edition, pages
Oslo: CREMAH, Norwegian Academy of Music, 2019
Series
CREMAH Anthology ; 11
Keywords
neonatal music therapy, Nordic perspective, family-centred care, infants, pain management
National Category
Musicology
Research subject
Musicology
Identifiers
urn:nbn:se:oru:diva-77701 (URN)
Note

Funding Agency:

Centre for Clinical Research, Region Värmland, Karlstad, Sweden

Available from: 2019-11-03 Created: 2019-11-03 Last updated: 2019-11-19Bibliographically approved
Ullsten, A., Volgsten, U., Klässbo, M. & Eriksson, M. (2019). Live lullaby singing during painful procedures in preterm and term infants. In: : . Paper presented at 12th International Symposium on Pediatric Pain (ISPP 2019), Basel, Switzerland, June 16-20, 2019.
Open this publication in new window or tab >>Live lullaby singing during painful procedures in preterm and term infants
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction: Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Infant-directed singing is a multisensory biopsychosocial communication that also applies to ill and vulnerable hospitalised infants. The first Nordic implementation process of family-centred neonatal music therapy started in Sweden at the Central Hospital in Karlstad by the first author in March 2010 (Fig. 1). Live lullaby singing during painful procedures is the first clinical trial to measure the pain-relieving effects of live lullaby singing during venepuncture in preterm and term neonates.

Method: 38 infants were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live by a music therapy student and standard care (facilitated tucking and oral glucose) was provided for all infants. Behavioural and physiological pain responses were assessed. The data from the RCT was analysed with qualitative and quantitative methods.

Results: During the lullaby procedures the physiological patterns were more stable and regular. Lullaby singing significantly calmed the infants’ respiration before venepuncture (Fig. 2). There were nonsignificant indications of fewer and shorter skin punctures with lullaby singing. The behavioural pain responses did not show any significant differences between the live lullaby singing and standard care procedures, however, nor did they indicate that live lullaby singing was harmful or stressful.

Conclusion: Live singing with infants is a biopsychosocial communicative interaction. A music therapist specialised in family-centred neonatal music therapy methods can mentor parents how to use live lullaby singing in connection to painful procedures. More research is needed to explore the potential benefits of family-centred music therapy as procedural support including the voice of the parents.

Keywords
Pain management, premature infants, music therapy, infant directed singing, lullaby
National Category
Musicology Nursing
Identifiers
urn:nbn:se:oru:diva-74654 (URN)
Conference
12th International Symposium on Pediatric Pain (ISPP 2019), Basel, Switzerland, June 16-20, 2019
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-06-12Bibliographically approved
Ullsten, A., Eriksson, M. & Axelin, A. (2019). O Parent, Where Art Thou? [Letter to the editor]. Paediatric & Neonatal Pain, 1(2), 53-55
Open this publication in new window or tab >>O Parent, Where Art Thou?
2019 (English)In: Paediatric & Neonatal Pain, E-ISSN 2637-3807, Vol. 1, no 2, p. 53-55Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Pediatrics
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-78845 (URN)10.1002/pne2.12010 (DOI)
Available from: 2019-12-31 Created: 2019-12-31 Last updated: 2020-02-14Bibliographically approved
Ullsten, A. (2019). Singing, sharing, soothing: Family-centred music therapy during painful procedures in neonatal care. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Singing, sharing, soothing: Family-centred music therapy during painful procedures in neonatal care
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

To sing is to communicate. The soothing, comforting and emotional regulating properties of a lullaby are well-known cross-culturally and historically. This doctoral thesis addresses neonatal pain management from a novel and groundbreaking perspective, studying the efficacy of live music therapy on infants’ pain responses during venepuncture. New research is needed to advance the non-pharmacological interventions in neonatal pain care, and neonatal music therapy (NICU MT) offers active methods to involve the parents in pain management. The doctoral thesis includes two empirical and two theoretical articles. In paper I, preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a crossover design. Parent-preferred lullabies were performed live by a music therapy student and standard care was provided for all infants. The results did not show any significant pain-alleviating effects, however, the live singing was not stressful for the infants.

In paper II, the microanalysis disclosed that live lullaby singing is a communicative reciprocal intervention that also applies to premature infants during painful procedures. Live lullaby singing is a tool suitable as a means to optimise the homeostatic mechanisms. The results from the theoretical papers III and IV are further developed and synthesised in the thesis into a theoretical strategy; The Nordic NICU MT pain management strategy, featuring the parents and their singing voices as mediators for pain relief. The role of the music therapist in neonatal pain management is as a facilitator and an educator for the parents. Coaching parents to better meet their infant’s attachment needs during a painful procedure may lead to more efficacious interventions. The biopsychosocial parental infant-directed singing is presumably an applicable parent-driven non-pharmacological intervention, which promotes pain relief and attachment formation during painful procedures. Neonatal music therapy is still in its infancy in the Nordic countries, but the societal and healthcare contexts afford important prerequisites to further develop NICU MT as a truly family-centred approach. This doctoral thesis will hopefully contribute to the important interdisciplinary endeavour worldwide of involving and integrating parents in neonatal pain management.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 134
Series
Örebro Studies in Musicology ; 4
Keywords
music therapy, pain management, premature infants, family-centred, infant-directed singing, venepuncture, parents, dynamic forms of vitality
National Category
Musicology
Identifiers
urn:nbn:se:oru:diva-77285 (URN)978-91-7529-313-4 (ISBN)
Public defence
2019-12-13, Örebro universitet, Hörsalen, Musikhögskolan, Fakultetsgatan 1, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2019-11-20Bibliographically approved
Ullsten, A., Eriksson, M., Klässbo, M. & Volgsten, U. (2018). Family-centred music therapy during painful procedures in neonatal care. In: : . Paper presented at PEARL/PICH2Go-meeting, Copenhagen, Denmark, March 25-27, 2018.
Open this publication in new window or tab >>Family-centred music therapy during painful procedures in neonatal care
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Musicology
Identifiers
urn:nbn:se:oru:diva-66232 (URN)
Conference
PEARL/PICH2Go-meeting, Copenhagen, Denmark, March 25-27, 2018
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2018-04-04Bibliographically approved
Ullsten, A., Eriksson, M., Klässbo, M. & Volgsten, U. (2018). Family-centred music therapy during painful procedures in neonatal care. In: : . Paper presented at 9th Nordic Music Therapy Congress, Stockholm, Sweden, August 8-12, 2018.
Open this publication in new window or tab >>Family-centred music therapy during painful procedures in neonatal care
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: During the most vulnerable period in a child’s life, preterm and sick newborns are exposed to a high number of painful procedures, sometimes without the comfort of their parents. Repeated pain and frequent use of opioids can have consequences for the neurological and behaviour-oriented development of the infant.It is vital to identify a repertoire of effective non-pharmacological interventions.

Method: Preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live by a music  therapy student. Standard care (facilitated tucking and oral glucose) was provided for all neonates. Behavioural and physiological pain responses were assessed.

Results: Live singing with newborn infants is a social communicative interaction. If the vocal performance is predictable and regular from start, it may optimize homeostasis during painful procedures. However, the live lullaby singing did not show a statistically significant effect on the infants' pain score. There was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing.

Conclusion: The additive effect of live lullaby singing has not been shown to alleviate infants’ behavioural pain responses during venepuncture; nor has it been shown to be stressful. Pain involves the interaction of biopsychosocial and situational factors,  therefore more research is needed to explore the potential benefits of music therapy including the role of the parents.

Keywords
Pain management, infants, music therapy
National Category
Musicology
Research subject
Musicology
Identifiers
urn:nbn:se:oru:diva-68457 (URN)
Conference
9th Nordic Music Therapy Congress, Stockholm, Sweden, August 8-12, 2018
Available from: 2018-08-14 Created: 2018-08-14 Last updated: 2018-08-15Bibliographically approved
Ullsten, A., Eriksson, M., Klässbo, M. & Volgsten, U. (2018). Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach. Music & Science, 1, 1-13
Open this publication in new window or tab >>Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach
2018 (English)In: Music & Science, ISSN 2059-2043, Vol. 1, p. 1-13Article in journal (Refereed) Published
Abstract [en]

Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Parental infant-directed singing is a multisensory, biopsychosocial communication that applies to ill and vulnerable hospitalised infants. The primary musical features of infant-directed singing are ideal for emotional coordination and sharing between parent and infant without the risk of over-stimulation. In this article, we suggest that parental infant-directed singing is regarded as a nonpharmacological emotion regulation intervention, which may modify the painful experience for both the infant and the parent before, during and after painful procedures in the neonatal intensive care context. Parents have the biopsychosocial resources to alleviate their infant’s pain through infant-directed singing, if they are empowered to do so and coached in this process. A music therapist specialised in neonatal music therapy methods can mentor parents in how to use entrained and attuned live lullaby singing in connection to painful procedures. Pain and the vast amount of painful procedures early in infancy, combined with early parent–infant separation and lack of parental participation in the care of the infant during neonatal intensive care, place arduous strain on the new family’s attachment process and on the infant’s and parents’ mental health, both from a short and long-term perspective. Therefore, we argue with biopsychosocial rationales, that live parental infant-directed singing should be promoted in neonatal pain care worldwide. Consequently, parents should be welcomed round the clock and invited as prescribed pain management for their infant.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Affect attunement, biopsychosocial, infant, infant-directed singing, music therapy, pain management, parent, vitality affects
National Category
Musicology
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-67535 (URN)10.1177/2059204318780841 (DOI)
Available from: 2018-06-27 Created: 2018-06-27 Last updated: 2019-11-19Bibliographically approved
Ullsten, A., Hugoson, P., Forsberg, M., Forzelius, L., Klässbo, M., Olsson, E., . . . Eriksson, M. (2017). Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates. In: : . Paper presented at Forum Värmland 2017, Landstinget i Värmland och Karlstads universitet, Karlstad, Sweden, February 14, 2017.
Open this publication in new window or tab >>Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
Show others...
2017 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Acute and repeated pain has long-term negative impact on infants’ development and future behaviour. The use of analgesic drugs has negative side-effects, which emphasizes the need for complementary approaches to pain management.

Aim: This study is the first clinical trial measuring if live lullaby singing can influence behavioural and physiological pain responses during venepuncture in preterm and term neonates.

Method: Preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioural and physiological pain responses were assessed.

Results: The live lullaby singing did not show a statistically significant effect on the infants’ pain score. There was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing.

Conclusions: The additive effect of live lullaby singing has not been shown to alleviate infants’ behavioural pain responses during venepuncture; however nor has it been shown to be harmful. More research is needed to explore the potential benefits of music therapy including the role of the parents.

Keywords
newborn infant, preterm infant, pain, music therapy, lullaby
National Category
Medical and Health Sciences
Research subject
Musicology
Identifiers
urn:nbn:se:oru:diva-57539 (URN)
Conference
Forum Värmland 2017, Landstinget i Värmland och Karlstads universitet, Karlstad, Sweden, February 14, 2017
Available from: 2017-05-03 Created: 2017-05-03 Last updated: 2019-03-29Bibliographically approved
Ullsten, A., Hugosson, P., Forsberg, M., Forzelius, L., Klässbo, M., Olsson, E., . . . Eriksson, M. (2017). Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates. Music and Medicine, 9(2), 73-85
Open this publication in new window or tab >>Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
Show others...
2017 (English)In: Music and Medicine, ISSN 1943-8621, Vol. 9, no 2, p. 73-85Article in journal (Refereed) Published
Abstract [en]

This clinical trial tested the pain relieving effect of live lullaby singing on behavioral and physiological pain responses during venepuncture in 38 preterm and full term neonates. Acute and repeated pain, as well as the use of analgesic drugs, may have long-term negative impact on infants’ development and future behaviour. This emphasizes the need for complementary approaches to pain management such as music therapy.

Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioral responses with regard to pain were assessed with Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIIP). Heart rate, respiratory rate and oxygen saturation were measured each tenth second.

Although the live lullaby singing did not show a statistically significant effect on the infants’ pain score, there was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage, showing a non-significant trend towards higher oxygen saturation levels and calmer heart rate in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing. More research is needed to explore such positive trends in the data.

Place, publisher, year, edition, pages
PKP Publishing Services, 2017
Keywords
newborn infant, preterm infant, pain, music therapy, lullaby
National Category
Pediatrics
Research subject
Musicology
Identifiers
urn:nbn:se:oru:diva-68308 (URN)
Available from: 2018-07-31 Created: 2018-07-31 Last updated: 2019-11-19Bibliographically approved
Ullsten, A. (2017). Family-centred music intervention - an emotional factor that modulates, modifies and alleviates infants' pain experiences. Acta Paediatrica, 106(3), 361-362
Open this publication in new window or tab >>Family-centred music intervention - an emotional factor that modulates, modifies and alleviates infants' pain experiences
2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 3, p. 361-362Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2017
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-57016 (URN)10.1111/apa.13731 (DOI)000397404700005 ()28186375 (PubMedID)2-s2.0-85011957263 (Scopus ID)
Available from: 2017-04-12 Created: 2017-04-12 Last updated: 2018-02-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4436-4258

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