To Örebro University

oru.seÖrebro University Publications
Change search
Refine search result
1 - 42 of 42
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1. Andreasson, Matilda
    et al.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Örebro University, School of Music, Theatre and Art.
    State of the art in parent-delivered pain-relieving interventions in neonatal care2021Conference paper (Refereed)
    Abstract [en]

    Objectives: Parent’s active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. 

    Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care. Specific objectives of the scoping review were to:1. Explore the breadth and extent of the literature, identify the types of available evidence, map and summarize the evidence, and inform future research on parent-delivered pain- and stress-relieving interventions in neonatal care. 2. Describe parents’ experiences of delivering pain and pain-related stress relief to their newborn infant. 3. Map and summarize recommendations as well as define knowledge gaps in national and international guidelines and in professional organizations or networks.

    
Results: There is strong evidence for the efficacy of skin-to-skin contact and breastfeeding, 
preferably in combination. These parent-delivered interventions are safe, valid, and ready for 
 prompt introduction in infants’ pain care globally. Research into parents’ motivations for, and 
experiences of, alleviating infant pain is scarce. More research on parent-delivered 
pain alleviation, including relationship-based interventions such as the parent’s musical 
presence, is needed to advance infant pain care. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of 
combining these interventions and to address parent involvement in low-income and low-tech 
settings.

    
Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain 
management for infants’ procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and 
parent, but also of health care.

  • 2.
    Arribas, Christina
    et al.
    Department of Pediatrics, Neonatal Intensive Care Unit, Clínica Universidad de Navarra, Madrid, Spain.
    Cavallaro, Giacomo
    Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
    Gonzalez, Juan-Luis
    Department of Statistics and Operations Research, Faculty of Medicine, University of Cadiz, Cádiz, Spain.
    Lagares, Carolina
    Department of Statistics and Operations Research, Faculty of Medicine, University of Cadiz, Cádiz, Spain.
    Raffaeli, Genny
    Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy .
    Smits, Anne
    Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
    Simons, Sinno H. P.
    Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center—Sophia Children’s Hospital, Rotterdam, The Netherlands.
    Villamor, Eduardo
    MosaKids Children’s Hospital, Maastricht University Medical Center (MUMC + ), School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, The Netherlands.
    Allegaert, Karel
    Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands; Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium .
    Garrido, Felipe
    Department of Pediatrics, Neonatal Intensive Care Unit, Clínica Universidad de Navarra, Madrid, Spain.
    Ullsten, Alexandra (Contributor)
    Örebro University, School of Health Sciences.
    Olsson, Emma (Contributor)
    Örebro University, School of Health Sciences.
    Gradin, Maria (Contributor)
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Carlsen Misic, Martina (Contributor)
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Montgomery, Scott (Contributor)
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI)2024In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447Article in journal (Refereed)
    Abstract [en]

    Background: There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress.

    Methods: This was a global, prospective, cross-sectional study. A survey was distributed May–November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location.

    Results: The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others.

    Conclusions: Socio-economic status of countries impacts on neonatal analgosedation management.

  • 3.
    Carlsen Misic, Martina
    et al.
    Örebro University, School of Health Sciences. Region Örebro län, Örebro University Hospital.
    Olsson, Emma
    Örebro University, School of Health Sciences. Region Örebro län, Örebro University Hospital.
    Ericson, Jenny
    Högskolan Dalarna.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Thernström-Blomqvist, Ylva
    Uppsala universitet.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Region Värmland.
    Parents as pain management in Swedish neonatal care – SWEpap2024Conference paper (Refereed)
    Abstract [en]

    Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-center clinical study. Using a mixed methods approach, SWEpap investigates combined parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain alleviation. This approach is consistent with a modern understanding of pain and of family-integrated care. Today non-pharmacological strategies are considered the first choice in neonatal pain management, and parent-delivered interventions are valuable but often overlooked resources in the procedural pain management in newborn infants. Research shows that parents desire to be actively involved. More research on parents’ experiences of being active in pain alleviation is needed, as well as research on the effectiveness of combined parent-delivered pain management including relationship-based interventions as the parent’s musical presence.  The qualitative part of the project is investigating the experiences and attitudes of parents and nurses towards combined parent-delivered pain management. The study applies a collaborative participatory action research (PAR) design with ethnographic inspired data collection in form of focus groups, video-observations, and video-stimulated recall interviews for data collection.  ResultsPreparation was considered the key for combined parent-delivered pain management. Both parents and nurses emphasized the importance of allowing time for the parent-infant dyad to calm down together before the painful procedure to cope with the situation. The combined parent-delivered pain management was considered feasible by both parents and nurses. Parents expressed that the singing helped them focus on their infant instead of the procedure. The parental lullaby singing created a calm and trusting atmosphere, affecting not only the parent-infant dyad but also the nurses. After the procedure both parents and nurses felt that they have successfully supported the infant through a painful procedure.  The second part of the ongoing SWEpap project is a randomized controlled trial investigating the efficacy of combined parent-delivered pain management with live parental lullaby singing, skin-to-skin contact, and breastfeeding compared with standard pain care during routine blood sampling of healthy newborn infants.

  • 4.
    Carlsen Misic, Martina
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics.
    Olsson, Emma
    Örebro University, School of Health Sciences. Department of Pediatrics.
    Ericson, Jenny
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Pediatrics, Falun Hospital, Falun, Sweden.
    Thernström Blomqvist, Ylva
    Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Andersen Dovland, Randi
    Department of Research, Telemark Hospital Trust, Skien, Norway; Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Örebro University Hospital. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Parent-delivered pain-relieving interventions in Swedish neonatal care, a mixed methods study2022Conference paper (Refereed)
    Abstract [en]

    Background: For improving the management of infant pain and translating research into practice, parents’ active involvement during painful procedures is considered a critical first step. Research into parents’ motivations for and experiences of alleviating infant pain, is scarce. More research on combined parent-delivered pain alleviation including relationship-based interventions such as the parent’s musical presence is needed to advance infant pain care.

    Aim: Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-center clinical study. Using a mixed methods approach, SWEpap investigates parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief. This approach is consistent with a modern understanding of pain and of family-integrated care.

    Material and method: The qualitative part of the SWEpap study applies collaborative participatory action research design, video observations and interviews to investigate health care professionals’ and parents’ motivational factors in and experiences of parent- delivered pain alleviation. The second part is a randomized controlled trial. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine blood sampling of newborn infants. The enrollment has started and is expected to be completed during 2023.

    Results: Preliminary results acknowledge the need for parents to be educated and prepared about the effectiveness of the parent-delivered methods and how to apply them prior to the procedure. In addition, when preparing for the actual procedure, both parents and health care professionals emphasize the importance of allowing the parents sufficient time to cope with the situation and the dyad to relax before the skin puncture.

    Conclusion: Video observations and interviews with parents and health care professionals indicate that parent- delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact are feasible pain treatment methods during painful procedures.

  • 5.
    Carlsen Misic, Martina
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Olsson, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Ericson, Jenny
    Health and Social Studies, Dalarna University, Falun, Sweden. Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden. Department of Pediatrics, Falun Hospital, Falun, Sweden.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Centre for Clinical Research, Region Värmland, Karlstad, Sweden .
    “Having my boy on my chest, humming to him, made us both very calm.”: Parents to new-born infants rated parent-delivered pain management as significantly meaningful during venepuncture2023Conference paper (Refereed)
    Abstract [en]

    Background:

    Parents are a valuable but underutilized resource in procedural pain management in newborn infants. Parents want to take an active role in their infants’ pain management.  Yet, there is a lack of knowledge concerning the parents’ experiences of providing pain management.  Newborn infants experience several painful procedures related to postnatal care and immunizations. Not all infants receive adequate pain management during these procedures causing unnecessary suffering and leaves the infant at risk of complications. Parent-delivered pain management such as skin to skin contact and breastfeeding alleviate the infant’s pain during painful procedures. Live parental infant-directed lullaby singing has not been previously investigated during painful procedures. Infant-directed singing can be an apt medium for parents and infants to communicate in affective mutual relationship during painful procedures. Parents have a unique expertise about their infants and by including them in the pain management they could become valuable partners for the health professionals. The aim of the study was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant. 

    Method: 

    This study was part of a multi-center randomized controlled trial (RCT) with three parallel groups of healthy newborn infants and their parents. The SWEpap study (Parents as pain management in Swedish neonatal care), investigates the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, and compared with just holding skin-to-skin during routine metabolic screening of newborn infants. The infant-parent dyads were randomly assigned to one of three treatment groups. For the parents’ ratings of meaningfulness, a visual analogue scale (VAS) with a 100mm line anchored at the ends is used; from “not meaningful” on the left end point, up to “most possible meaningful” on the right end point of the scale. The parents were also asked to give their verbal comment on how they experienced the blood sampling situation and providing pain management.  

    Results: 

    A total number of 151 newborn infants with at least one parent, participated in the study. Mean gestational age was 39.6 w., mean birth weight was 3547 g., and 49,7 % were girls.  The mean VAS-ratings for meaningfulness were 82.1 in the standard care group, 89.5 in the skin-to-skin group and 88.9 in the combined intervention group. The ratings in the two groups with parent-delivered pain-alleviation were significantly higher than in the standard care group (p=0.036).  Parents in all groups expressed that it was meaningful to provide pain-relief and participate in the pain management of their newborn infant.  “Very meaningful. It felt much safer to have her close to me during the skin puncture. Usually, she is on the examination table which gives an unsecure feeling because when she is in pain you can’t do anything as a parent.” (Mother, skin-to-skin group) “It felt very good to make a positive impact. Singing went very well. I usually sing all the time at home.” (Father, combined group) “I could control the syringe with glucose which made me less helpless as a parent because I could contribute.” (Parent, standard care group) Some parents commented that providing pain management helped themselves to overcome their own fears. “I am scared of needles myself and has been worrying about needles and blood but this went really well. She was so calm, gave not a sound. I could also relax when she was calm.” (Mother, skin-to-skin group) Parents also compared with previous blood sampling situations. “My previous child was totally hysteric during blood sampling on the examination table. Today, the baby was absolutely calm.” (Parent, combined group)  Finally, many parents expressed that they wanted to continue providing parent-delivered pain management in the future. “I can absolutely think to use this pain relief combination in the future. He does recognize the singing and my voice from before.” (Mother, combined group)  

    Conclusions: 

    The findings of this study shows that parents find it meaningful to provide parent-delivered pain-alleviating interventions during painful procedures in postnatal care. The parents in the skin-to-skin group and the group that combined skin-to-skin, breastfeeding, and live parental lullaby singing expressed that they wanted to keep using these methods in future painful situations as well. Even parents with fear of needles felt it was meaningful to participate in parent-delivered pain-alleviating pain management since their participation blunted their own fear.  Relevance for patient care: All newborn infants are subjected to painful procedures during the first months of life and pain-relieving methods are insufficiently used. Modern neonatal care strives to be family oriented with a high degree of parental participation. This must also be the case with pain management and parents must be given tools and opportunities to be an active agent in their infant’s pain management. 

  • 6.
    Carlsen Misic, Martina
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Olsson, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Ericson, Jenny
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Pediatrics, Falun Hospital, Falun, Sweden.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Parents to new-born infants rated parent-delivered pain management as significantly meaningful during venepuncture2023In: Örebro University's Nobel Day Festivities: Book of Abstracts, 2023Conference paper (Refereed)
    Abstract [en]

    Background/Objective: Parents express great readiness to actively deliver comfort for their infant during painful procedures. Previous research shows evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. Live parental lullaby singing combined with skin-to-skin contact and breastfeeding has not previously been investigated during painful procedures. Parents as pain management in Swedish neonatal care (SWEpap), is a cutting-edge interdisciplinary multi-center study with mixed methods. The randomized controlled trial investigates the efficacy of combined parent-delivered pain management compared with standard care during routine blood sampling of healthy newborn infants.

    Method: The aim of this analysis was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant in the three treatment groups; standard care with glucose, skin-to-skin contact, or a combination of skin-to-skin contact, breastfeeding (if applicable) and live parental lullaby singing. The parents rated the meaningfulness of the various conditions on a 100 mm visual analogue scale (VAS) from “not meaningful” on the left end point, up to “most possible meaningful” on the right end point of the scale. The parents were also asked to comment on how they experienced providing pain management.

    Result: A total number of 151 newborn infants with at least one parent, participated in this analysis. The mean VAS-ratings for meaningfulness were 82.1 for standard care with glucose, 89.5 for skin-to-skin contact, and 88.9 for combined interventions with live parental lullaby singing, breastfeeding and skin-to-skin contact. The ratings for parent-delivered pain-alleviation were significantly higher than for standard care (p=0.036). Parents in all groups expressed that it was meaningful to provide pain-relief and participate in the pain management of their newborn infant.

    Conclusion: Parents found it meaningful to provide parent-delivered pain-alleviating interventions with skin-to-skin contact, breastfeeding and live parental lullaby singing during painful procedures in postnatal care. The parents stated that they will continue using these methods in future painful situations.

  • 7.
    Carlsen Misic, Martina
    et al.
    Örebro University, School of Health Sciences.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Örebro University Hospital. Centre for Clinical Research, Region Värmland, Sweden.
    Olsson, Emma
    Örebro University, School of Health Sciences.
    Andersen, Randi Dovland
    Örebro University, School of Health Sciences. Telemark Hospital Trust, Norway; University of Oslo, Norway.
    Ericson, Jenny
    Dalarna University, Sweden; Uppsala University, Sweden; Falun Hospital, Swede.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Thernström Blomqvist, Ylva
    Neonatal Intensive Care Unit, University Hospital, Sweden; Uppsala University, Sweden.
    Balancing power by including parents as co-researchers: Live parental singing, breastfeeding, skin-to-skin-contact as procedural support in Swedish neonatal pain care2022Conference paper (Refereed)
    Abstract [en]

    Frequent and inadequately treated pain combined with separation from the parent cause adverse interruptions to the parent-infant attachment process. The pain might harm the infant physically and psychologically including increasing the risk for abnormally heightened sensitivity to pain. Effective pain management strategies are needed and parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief, is consistent with a modern understanding of pain and of family-integrated care. Important for translating research into practice is to involve healthcare professionals and parents as co-researchers. Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. The Nordic neonatal music therapy pain management strategy provides a theoretical and practical resource-oriented music therapy model of how parent-delivered infant-directed singing can be comprehensively used in interdisciplinary neonatal pain research. Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-centre clinical study with mixed methods. The collaborative participatory action research design for the qualitative part of the SWEpap study aims to democratise the research process involving both parents and health professionals in the knowledge-making. The second part of SWEpap is a randomised controlled trial informed by music therapy expertise and research using the Nordic neonatal music therapy pain management strategy as a theoretical framework for its design. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine metabolic screening of newborn infants.

  • 8.
    McMurtry, C. Meghan
    et al.
    University of Guelph, Canada .
    Provenzi, Livio
    IRCCS Mondino Foundation, Pavia, Italy .
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Centre for Clinical Research, Region Värmland, Sweden.
    Speak Up! The Parent’s Voice and Musical Presence During Painful Procedures in Neonatal and Paediatric Care2022Conference paper (Refereed)
    Abstract [en]

    Although pain is best understood from a biopsychosocial perspective, the social context of pain is often overlooked. For infantsand children undergoing painful medical procedures, parents are a key social factor who can influence pain outcomes. Parents’feeling of being helpful to their child can contribute to a sense of control over a challenging situation and affirm their parental role.Integrating parents in procedural support and pain management is consistent with family integrated care and helps equip parentswith nurturing skills they can use beyond the acute period. Yet major gaps exist in our knowledge about parent-child interactionsduring their children’s pain which would inform best practices including a focus on how parents speak to their children (i.e.,beyond what they say), the role of fathers, and singing as serving an important communicative function. In an interdisciplinaryworkshop, three talks will explore the voice of parents in infant, child and youth procedural pain. The first talk will provide datafrom a cutting edge scoping review of parental vocal cues in the context of their children’s pain and relations to child outcome.The second talk will focus on fathers including their experience with the neonatal intensive care unit (NICU) and father-ledinterventions for infant pain. In the third talk, we argue that music therapy via singing provides a means through which parentscan access and learn to use their nurturing resources to promote neonatal procedural support. Results from new research whereparents and health professionals are included as co-researchers to identify facilitators for parent-delivered pain management willbe presented. This workshop will include critical reflections of the available research evidence including key areas for futureresearch and translating what is known into effective practice.

  • 9.
    Olsson, Emma
    et al.
    Örebro University, School of Health Sciences. Department of Pediatrics.
    Carlsen Misic, Martina
    Örebro University, School of Health Sciences. Department of Pediatrics.
    Dovland Andersen, Randi
    Department of Research, Telemark Hospital Trust, Skien, Norway; Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
    Ericson, Jenny
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden; Department of Pediatrics, Falun Hospital, Falun, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Thernström Blomqvist, Ylva
    Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences.
    Study protocol: parents as pain management in Swedish neonatal care - SWEpap, a multi-center randomized controlled trial2020In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 20, no 1, article id 474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the first period of life, critically ill as well as healthy newborn infants experience recurrent painful procedures. Parents are a valuable but often overlooked resource in procedural pain management in newborns. Interventions to improve parents' knowledge and involvement in infants' pain management are essential to implement in the care of the newborn infant. Neonatal pain research has studied a range of non-pharmacological pain alleviating strategies during painful procedures, yet, regarding combined multisensorial parent-driven non-pharmacological pain management, research is still lacking.

    METHODS/DESIGN: A multi-center randomized controlled trial (RCT) with three parallel groups with the allocation ratio 1:1:1 is planned. The RCT "Parents as pain management in Swedish neonatal care - SWEpap", will investigate the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, during routine metabolic screening of newborn infants (PKU-test).

    DISCUSSION: Parental involvement in neonatal pain management enables a range of comforting parental interventions such as skin-to-skin contact, breastfeeding, rocking and soothing vocalizations. To date, few studies have been published examining the efficacy of combined multisensorial parent-driven interventions. So far, research shows that the use of combined parent-driven pain management such as skin-to-skin contact and breastfeeding, is more effective in reducing behavioral responses to pain in infants, than using the pain-relieving interventions alone. Combined parental soothing behaviors that provide rhythmic (holding/rocking/vocalizing) or orogustatory/orotactile (feeding/pacifying) stimulation that keep the parent close to the infant, are more effective in a painful context. In the SWEpap study we also include parental live lullaby singing, which is an unexplored but promising biopsychosocial, multimodal and multisensory pain alleviating adjuvant, especially in combination with skin-to-skin contact and breastfeeding.

    TRIAL REGISTRATION: ClinicalTrials.gov ( NCT04341194 ) 10 April 2020.

  • 10.
    Silberstein Katzeff, Aviva
    et al.
    Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden; Centre for Traumatic Stress, Region Värmland, Karlstad, Sweden.
    Ligård, Emmy
    Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden.
    Edlund, Sara M.
    Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Family-centered Music Therapy as Procedural Support in the Pediatric Outpatient Unit: A Mixed Methods Pilot Study2024In: Music & Science, E-ISSN 2059-2043Article in journal (Refereed)
    Abstract [en]

    Needle procedures are one of the most common reasons for children to visit hospitals. If unaddressed, negative needle experiences can worsen over time and lead to needle noncompliance, needle fears, and healthcare avoidance. This mixed methods pilot study tested the effect of combined music therapy and standard pharmacological care compared to standard care alone on fear and discomfort in children in connection to a scheduled needle procedure. Children and their parents were also interviewed on their general experience of music therapy and how they regulated fear and discomfort during needle procedures while participating in music therapy. Thirty children aged 0 to 15 and their parents were recruited at the pediatric outpatient unit at The Central Hospital in Karlstad, Sweden. The participants were randomized to an intervention group with music therapy and to a control group that received standard care alone. The children rated their fear and discomfort before, during and after a needle procedure on a child-friendly visual analogue scale. The children and parents who were randomized to the music therapy condition were interviewed about their experiences of music therapy as procedural support. No significant differences between the intervention group and the group with standard care alone were found, indicating that the two groups were equivalent with regard to experienced fear and discomfort. The content analysis of the interviews indicated that the children and their parents considered that the music therapy intervention promoted the participants’ emotion regulation, promoted adaptive coping strategies for both children and the parents, and favorably but also ambivalently affected the context and interactions in the procedural room.

  • 11.
    Ullsten, Alexandra
    Örebro University, School of Music, Theatre and Art. Music and Art Therapy Department, Värmland County Council, Karlstad, Sweden.
    Family-centred music intervention - an emotional factor that modulates, modifies and alleviates infants' pain experiences2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 3, p. 361-362Article in journal (Refereed)
  • 12.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences.
    Muzykoterapia z muzyką na żywo i śpiewaniem kołysanek jako wsparcie emocjonalne podczas bolesnych zabiegów: Uzasadnienie dla śpiewania piosenek w ramach leczenia bólu u noworodków [Live music therapy with lullaby singing as affective support during painful procedures: rationales for parental infant-directed singing in neonatal pain management]2020In: Muzykoterapia dzieci przedwcześnie urodzonych i ich rodzin: Teoria i praktyka / [ed] Bieleninik, Ł.; Konieczna-Nowak, L., Warszawa: Wydawnictwo Naukowe Scholar , 2020, p. 175-188Chapter in book (Refereed)
  • 13.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Parents as nurturing resources: A family integrated approach to music therapy for neonatal procedural support.2022Conference paper (Refereed)
    Abstract [en]

    Music therapy provides a means through which parents can learn to use their nurturing resources. Live infant directed singing is a relationship-based communication tool for parents in regulating the infant’s state, affects, and arousal levels and is therefore a suitable medium for parents to use during painful procedures.

    Pain is best understood from a biopsychosocial perspective. For infants undergoing painful medical procedures, parents are a key biopsychosocial resource who can influence pain outcomes. Parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief, is consistent with a modern understanding of pain and of family-integrated care. Parents’ feeling of being helpful to their infant can contribute to a sense of control over a challenging situation and affirm their parental role. Integrating parents in pain management helps equip parents with nurturing skills they can use beyond the acute period. 

    Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. Ullsten (2019) presents “the Nordic neonatal music therapy pain management strategy”, which is a family integrated biopsychosocial and resource-oriented theoretical and practical model. With this strategy, Ullsten adapts Ghetti’s (2012) working model of music therapy as procedural support to illustrate the theoretical underpinnings of a model in which parents assume primary caregiving roles during the provision of procedural support via parent-delivered interventions.

    This workshop will include critical reflections of the available research evidence including key areas for future research and translating what is known into effective practice. 

    References

    Ullsten A. Singing, sharing, soothing: Family-centred music therapy during painful procedures in neonatal care. Doctoral dissertation. Örebro: Örebro University; 2019. http://oru.diva-portal.org/smash/record.jsf?pid=diva2%3A1360872&dswid=9847

    Ghetti CM. Music therapy as procedural support for invasive medical procedures: Toward the development of music therapy theory. Nordic J Mus Ther. 2012;21(1):3-35. doi.org/10.1080/08098131.2011.571278

  • 14.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Parents as pain management: Live parental singing, breastfeeding and skin-to-skin-contact as procedural support in Swedish neonatal pain care2022Conference paper (Other academic)
  • 15.
    Ullsten, Alexandra
    Örebro University, School of Health Sciences. Music and Art Therapy Department, Central Hospital, Region Värmland, Karlstad, Sweden; Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Parents' live singing is a preventive and protective intervention for infants during painful procedures2024In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Other academic)
  • 16.
    Ullsten, Alexandra
    Örebro University, School of Music, Theatre and Art.
    Singing, sharing, soothing: Family-centred music therapy during painful procedures in neonatal care2019Doctoral 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.

    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
    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: 2024-03-04Bibliographically 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: 2023-05-22Bibliographically 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, E-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)2-s2.0-85092144488 (Scopus ID)
    Available from: 2018-06-27 Created: 2018-06-27 Last updated: 2023-12-08Bibliographically 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: 2022-06-21Bibliographically approved
    Download full text (pdf)
    Singing, sharing, soothing: Family-centred music therapy during painful procedures in neonatal care
    Download (png)
    Bild
    Download (pdf)
    Cover
    Download (pdf)
    Spikblad
  • 17.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Health Sciences. Örebro University, School of Music, Theatre and Art. Center for Clinical Research, Region Värmland, Karlstad, Sweden.
    Andreasson, Matilda
    Örebro University, School of Medical Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review2021In: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 9, article id 651846Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Parents’ active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. This scoping review synthesizes the available research to provide an overview of the state of the art in parent-delivered pain-relieving interventions.

    Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care.

    Results: There is a strong evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. These parent-delivered interventions are safe, valid, and ready for prompt introduction in infants’ pain care globally. Research into parents’ motivations for, and experiences of, alleviating infant pain is scarce. More research on combined parent-delivered pain alleviation, including relationship-based interventions such as the parent’s musical presence, is needed to advance infant paincare. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of combining these interventions and to address parent involvement in low-income and low-tech settings.

    Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain management for infants’ procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and parent but also of health care.

  • 18.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Health Sciences. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Andreasson, Matilda
    Faculty of Health and Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    State of the art in parent-driven pain and stress relieving interventions in neonatal care – a scoping review2020Other (Other academic)
    Abstract [en]

    Pain in the newborn period puts the individual at risk of developing short- (Hall & Anand, 2005) and long-term (Walker, 2019) negative consequences. To provide sufficient prevention and treatment of pain is a cornerstone of neonatal care. This should be done with a multimodal approach, using non-pharmacological and pharmacological interventions (Carter & Brunkhorst, 2017). Many of the supportive, non-pharmacological interventions can be delivered by the parents of the newborn infant (Franck, Oulton, & Bruce, 2012). Little is known to which extent these methods are recommended and used or how the parents experience being responsible for their child’s pain alleviation.

  • 19.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Health Sciences. Region Värmland.
    Carlsen Misic, Martina
    Örebro University, School of Health Sciences.
    Olsson, Emma
    Örebro University, School of Medical Sciences. Örebro University, School of Health Sciences. Örebro University Hospital.
    Andersen, Randi Dovland
    Örebro University, School of Health Sciences. Sykehuset Telemark HF, Skien, Norge.
    Ericson, Jenny
    Region Dalarna/Högskolan Dalarna.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Thernström Blomqvist, Ylva
    Region Uppsala.
    O parent where art thou?: Family-integrated music therapy forneonatal procedural support2023Conference paper (Refereed)
  • 20.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Axelin, Anna
    Department of Nursing Science, University of Turku, Turku, Finland.
    O Parent, Where Art Thou?2019In: Paediatric & Neonatal Pain, E-ISSN 2637-3807, Vol. 1, no 2, p. 53-55Article in journal (Refereed)
  • 21.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Family-centred music therapy during painful procedures in neonatal care2018Conference paper (Refereed)
  • 22.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre For Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Klässbo, Maria
    Centre For Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Family-centred music therapy during painful procedures in neonatal care2018Conference paper (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.

  • 23.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis2017In: Nordic Journal of Music Therapy, ISSN 0809-8131, Vol. 26, no 2, p. 142-166Article in journal (Refereed)
    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.

  • 24.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Landstinget i Värmland, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Klässbo, Maria
    Centrum för klinisk forskning, Landstinget i Värmland, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing as affective support during venepuncture. A case study with microanalysis of two premature born infants.2015Conference paper (Refereed)
  • 25.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Landstinget i Värmland, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Klässbo, Maria
    Centrum för klinisk forskning, Landstinget i Värmland, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing as affective support during venepuncture. A case study with microanalysis of two premature born infants.2015Conference paper (Refereed)
  • 26.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Landstinget i Värmland, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Klässbo, Maria
    Centrum för klinisk forskning, Landstinget i Värmland, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing as affective support during venepuncture. A case study with microanalysis of two premature born infants2016In: Musikforskning i dag, Linnéuniversitetet, Växjö, 14–16 juni 2016 / [ed] Lars Berglund, Växjö, Sweden: Linnéuniversitetet , 2016, p. 31-31Conference paper (Refereed)
    Abstract [en]

    Objective: 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 and affection of their parents. Since 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 effective non-pharmacological interventions with regard to procedural pain.

    Methods: Preterm and ill term neonates (n=38) were subjected to venepuncture with and without live infant-directed lullaby singing, in a randomised order with a cross over design. Physiological data were collected and the procedures were videotaped. Parents (n=11) and staff (n=11) were interviewed about live singing as affective support. From this larger study two premature infants were selected for a case study. Their behavioural and physiological responses as well as the liveperformed lullaby, were analysed in-depth with microanalysis.

    Results: Transcriptions of the lullaby-performances identified signs of “amodal perception” and “time in movement” by which the infants transposed the vocalization of the live-singing into their behaviour synchronizing in dance-like body gestures with the variations in intensity, shape and temporal structures of the vocal performance. Live singing with premature infants is a social communicative interaction which may optimize homeostasis during painful procedures if the lullaby singing is predictable and regular from start.

    Conclusion: Since emotional regulation is a central feature of music therapy this case study brings important clinical implications for how the affective interaction between the music therapist or the parent and the infant should be composed during painful procedures. 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.

    Download full text (pdf)
    Live music therapy with lullaby singing as affective support during venepuncture. A A case study with microanalysis of two premature born infants
  • 27.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing as affective support during venepuncture: A case study with microanalysis of two premature born infants2015Conference paper (Refereed)
    Abstract [en]

    Introduction: 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.

    Objective: The objectives were to analyze the live lullaby singing for two premature infants during venepuncture in comparison to standard care only, and the infants’ physiological and affective responses emerging before, during and after this procedure.

    Methods: Preterm and ill term infants (n=38) were subjected to venepuncture with and without live infant-directed lullaby singing, in a randomised order with a cross over design. Physiological data were collected and the procedures were videotaped. Two premature infants’ behavioural and physiological responses as well asthe live-performed lullaby, were analysed in-depth with microanalysis and with the pain assessment tool Behavioral Indicators of Infant Pain (BIIP).Results: Live singing with premature infants is a social communicative interaction. If the vocal performance is predictable and regular from start, it may optimize homeostasis during painful procedures.

    Conclusion: Since emotional regulation is a central feature of music therapy this case study brings important clinical implications for how the affective interaction between the music therapist or the parent and the infant should be composed during painful procedures.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.

  • 28.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing during painful procedures in neonatal care2016Conference paper (Refereed)
  • 29.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing during painful procedures in neonatal care2016In: Nordisk tidskrift for musikkterapi - Nordic Journal of Music Therapy, ISSN 0809-8131, E-ISSN 1944-8260, Vol. 25, no Suppl. 1, p. 79-Article in journal (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 emphasises the need for complementary approaches to pain management.

    Methods: Preterm and ill term neonates (n = 38) were subjected to venepuncture with and without live infant-directed lullaby singing, in a randomised order with a cross over design. Physiological data were collected and the procedures were videotaped for pain assessment. Parents (n = 11) and staff (n = 11) were interviewed about live singing as affective support. Two premature infants’ behavioural and physiological responses and the live-performed lullaby were analysed in-depth with microanalysis.

    Results: Live singing with premature infants is a social communicative interaction. If the vocal performance is predictable and regular from start, it may optimise homeostasis during painful procedures. Since pain involves the interaction of biopsychosocial and situational factors, more research is needed to explore the potential benefits of music therapy including the role of the parents.

  • 30.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Landstinget i Värmland, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Klässbo, Maria
    Centrum för klinisk forskning, Landstinget i Värmland, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing during painful procedures in neonatal care2016Conference paper (Refereed)
  • 31.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Landstinget i Värmland, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Klässbo, Maria
    Centrum för klinisk forskning, Landstinget i Värmland, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing during painful procedures in neonatal care2017Conference paper (Other academic)
  • 32.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach2018In: Music & Science, E-ISSN 2059-2043, Vol. 1, p. 1-13Article in journal (Refereed)
    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.

  • 33.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Health Sciences. Central Hospital, Karlstad, Sweden.
    Ettenberger, Mark
    Sono - Centro De Musicoterapia.
    Haslbeck, Friederike
    “The rocky horror NICU show” - challenges and potentials of disturbances in neonatal music therapy: A forum theatre workshop2022Conference paper (Refereed)
    Abstract [en]

    Disturbances, interruptions, and inconveniences are part of everyday work in the music therapist’s practice in the neonatal intensive care unit (NICU) and other hospital settings. Infants or parents are asleep, parents are busy breastfeeding, infants suffer from pain or painful procedures and staff comes and goes. Alarms are abruptly going off, CPAP machines and devices intended for respiratory support are hissing and buzzing, and sometimes even rounds seem to be more important than family and patient needs.

    These are well-known distracting situations a neonatal music therapist must relate to in her/his treatments with vulnerable and sick infants and their caregivers. Other disruptions are, however, both beneficial and welcome. Parents sing along in the music, staff and students stay to observe, siblings determine the songs, the head of the department comes by. These “disturbances” may create favourable circumstances for the music therapy service and the music therapist. 

    Our workshop performs four challenging everyday music therapy scenarios that music therapists from all sorts of clinical settings will recognize and which require different strategies, skills, and tools to manage. We will act out the unresolved disturbances, dilemmas, and possibilities. Instead of delivering premade solutions, we engage the audience to suggest and explore creative and therapeutically meaningful solutions to the various disruptions. Based on the principles of forum theatre developed by Augusto Boal, our workshop takes an interactive and participatory format such that the knowledge, aspirations, and capacities of the workshop participants may be brought to bear on the exploration of viable solutions on the stage. After observing the separate scenarios, the first time, the play is performed again, and invites the workshop audience to stop the play at any point, replace a character whose experience they may understand, and attempt to change the course of dramatic action. In our workshop, spectators are transformed into “spect-actors”, not only observing but acting to change the challenging situations they are presented. We aim to empower the workshop participants and facilitate spontaneity and creativity, collaboration, listening and awareness, communication, effective interaction, confidence and capacity, information and education, problem-solving and community development. Thereby we aim to widen our horizon of therapeutic responsiveness from the macro level of environmental circumstances to the micro-level of the tiniest patient signs.

  • 34.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Health Sciences. Department of Musicology, Örebro University, Örebro, Sweden; Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Gaden, Tora S.
    The Grieg Academy Music Therapy Research Centre, Bergen, Norway; NORCE, Bergen, Norway.
    Mangersnes, Julie
    Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Development of family-centered care informing Nordic neonatal music therapy2020In: Music in paediatric hospitals: Nordic perspectives / [ed] Lars Ole Bonde & Kjersti Johansson, Oslo: Norwegian Academy of Music , 2020, p. 1-23Chapter 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 infant focused,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 family-centred 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 child care, afford important prerequisites to further develop NICU MT as a truly family-centred approach.

  • 35.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Health Sciences.
    Gaden, Tora S.
    Mangersnes, Julie
    Nordic Countries: Family-Centered Cultural Sensitivity: A Cornerstone in Neonatal Music Therapy Implementation2020In: Music Therapy in Neonatal Intensive Care: Influences of Culture / [ed] Helen Shoemark & Mark Ettenberger, Dallas, TX: Barcelona Publishers, 2020Chapter in book (Refereed)
  • 36.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Värmland County Council, Karlstad, Sweden.
    Hugoson, Pernilla
    Department of Music, University of Jyväskylä, Jyväskylä, Finland.
    Forsberg, Malin
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, sweden.
    Forzelius, Lisa
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Klässbo, Maria
    Clinical Research Center, Värmland County Council, Karlstad, Sweden.
    Olsson, Emma
    Örebro University, School of Medical Sciences.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Westrup, Björn
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Ådén, Ulrika
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Bergqvist, Lena
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates2017Conference paper (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.

  • 37.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Hugosson, Pernilla
    Department of Music, University of Jyväskylä, Jyväskylä, Finland; Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden .
    Forsberg, Malin
    County Council of Dalarna, Mora Hospital, Mora, Sweden.
    Forzelius, Lisa
    County Council of Västernorrland, Sundsvall Hospital, Sundsvall, Sweden.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Olsson, Emma
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Westrup, Björn
    Department of Women’s and Children’s Health, Karolinska Institute, Karolinska University Hospital-Danderyd, Stockholm, Sweden.
    Ådén, Ulrika
    Neonatal Research Unit, Department of Women’s and Children’s Health, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Bergqvist, Lena
    Department of Clinical Science, Intervention and Technology, Unit of Pediatrics, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates2017In: Music and Medicine, ISSN 1943-8621, Vol. 9, no 2, p. 73-85Article in journal (Refereed)
    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.

  • 38.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Mangersnes, Julie
    Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Söderström Gaden, Tora
    The Grieg Academy Music Therapy Research Centre, Bergen, Norway. NORCE, Bergen, Norway.
    A Nordic perspective on family-centered neonatal music therapy2019Conference paper (Refereed)
    Abstract [en]

    Nordic neonatal music therapy (NICU MT) and research is still in its infancy. Systematic implementation work was first initiated in Karlstad, Sweden in 2010. In Norway, a few music therapists have for shorter periods worked in neonatal intensive care, but a more systematic implementation was initiated in Oslo in 2017. An ongoing paradigm shift in neonatal health care globally isthe concept of family-centered care. The Nordic countries are in the front line of welcoming and including both parents in the care of their infant around the clock. The Nordic neonatal music therapists and researchers have here unique opportunities to be truly family-centered working in partnership with both parents, including parents from non-Nordic cultures, guiding them to be equally involved in the infant-directed communication. A research area of great interest globally is parental participation in neonatal pain management. Nordic NICU MT has pioneer status in researching the pain alleviating effect of live singing during painful procedures. Family-centered NICU MT has potential to improve procedural pain care for both infants and their parents.The authors of this paper, who are also the Nordic implementation pioneers in NICU MT in Sweden and Norway, will discuss early experiences from our implementation work and show that models of practice are not directly transferable between different cultural contexts and health care systems. The authors will emphasize the importance of a cultural sensitivity in NICU MT implementation, where parents’ participation can be included already on the planning stage when building clinical programs and designing research studies.

  • 39.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Health Sciences.
    Pölkki, Tarja
    University of Oulu and Oulu University Hospital, Oulu, Finland.
    Ghetti, Claire
    The Grieg Academy, Department of Music, University of Bergen, Norway.
    Parents as nurturing resources: A family integrated approach to music therapy for neonatal procedural support2021In: Music and Medicine, ISSN 1943-863X, Vol. 13, no 2, p. 99-111Article in journal (Refereed)
    Abstract [en]

    Family integrated music therapy approaches may contribute significantly to the prevention and management of pain and discomfort in infants related to painful or distressing procedures, and the discipline of music therapy requires more sophistication in understanding how and why. In this perspective article, we advocate for the unique role parents play in neonatal pain management and for the importance of supporting and educating parents to actively engage in music therapy as procedural support. Infant-directed singing can be an apt medium for parents and infants to communicate in affective mutual relationship during painful procedures. Music therapists can collaborate with parents in a way that positions parents as experts and assures they are empowered in their roles. In doing so, music therapy both coordinates with and extends the interdisciplinary team’s initiatives to provide individualized, family integrated developmental care. Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. Theory development is essential in advancing music therapy research and practice in this field. In our perspective paper, we present the theoretical underpinnings of a family integrated approach to music therapy as neonatal procedural support where parents are the primary (re)sources for nurture and pain alleviation. 

  • 40.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Söderström Gaden, Tora
    The Grieg Academy Music Therapy Research Centre, Bergen, Norway; NORCE, Bergen, Norway.
    Mangersnes, Julie
    Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Development of family-centred care informing Nordic neonatal music therapy2019In: 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.

  • 41.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Söderström Gaden, Tora
    The Grieg Academy Music Therapy Research Centre, Bergen, Norway. NORCE, Bergen, Norway;.
    Mangersnes, Julie
    Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Development of family-centred care informing Nordic neonatal music therapy: Music in Paediatric Hospitals in the Nordic Countries2019Conference paper (Refereed)
  • 42.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Klässbo, Maria
    Region Värmland, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Live lullaby singing during painful procedures in preterm and term infants2019Conference paper (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.

1 - 42 of 42
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf