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Singing, sharing, soothing: Family-centred music therapy during painful procedures in neonatal care
Örebro University, School of Music, Theatre and Art.ORCID iD: 0000-0002-4436-4258
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 [en]
music therapy, pain management, premature infants, family-centred, infant-directed singing, venepuncture, parents, dynamic forms of vitality
National Category
Musicology
Identifiers
URN: urn:nbn:se:oru:diva-77285ISBN: 978-91-7529-313-4 (print)OAI: oai:DiVA.org:oru-77285DiVA, id: diva2:1360872
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
List of papers
1. Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
Open this publication in new window or tab >>Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates
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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
2. Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis
Open this publication in new window or tab >>Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis
2017 (English)In: Nordic Journal of Music Therapy, ISSN 0809-8131, Vol. 26, no 2, p. 142-166Article in journal (Refereed) Published
Abstract [en]

During the most vulnerable period in a child’s life, preterm and sick infants are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of analgesic drugs may have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. This paper reviews the use of live lullaby singing as an adjuvant to the control of premature infant pain. The objectives of this case study were to analyse the live lullaby singing for two premature infants during venipuncture in comparison to standard care only, and the infants’ physiological and affective responses emerging before, during and after this procedure. The empirical data stem from a quantitative clinical study. From this larger study, two premature infants were selected. Through microanalysis, with in-depth analysis of video footage, and pain assessment with Behavioral Indicators of Infant Pain (BIIP), painful standard care procedures with and without live lullaby singing, were analysed. The results show that live lullaby singing with premature infants is a communicative interaction which may optimize the homeostatic mechanisms of the infant during painful procedures. This case study shows the importance of predictability of the affective support, right from the start of the live singing intervention. It is important in a painful context that vocal interactions provide regular and comforting intensity, shape and temporal structures.

Place, publisher, year, edition, pages
Oxon, United Kingdom: Routledge, 2017
Keywords
Pain management, premature infants, music therapy, infant directed singing, lullaby
National Category
Musicology
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-49326 (URN)10.1080/08098131.2015.1131187 (DOI)000394440800004 ()2-s2.0-84988566335 (Scopus ID)
Note

Funding Agencies:

Värmland County Council, Sweden

Queen Silvia's Jubilee Fund, Sweden

Karin and Erik Gerdens Foundation, Sweden

Berit and Carl-Johan Wettergrens Foundation, Sweden

Available from: 2016-03-13 Created: 2016-03-13 Last updated: 2019-11-19Bibliographically approved
3. Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach
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
4. Development of family-centred care informing Nordic neonatal music therapy
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

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