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  • 1.
    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)
  • 2.
    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: 2019-11-19Bibliographically approved
    2. Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis
    Open this publication in new window or tab >>Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis
    2017 (English)In: Nordic Journal of Music Therapy, ISSN 0809-8131, Vol. 26, no 2, p. 142-166Article in journal (Refereed) Published
    Abstract [en]

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

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

    Funding Agencies:

    Värmland County Council, Sweden

    Queen Silvia's Jubilee Fund, Sweden

    Karin and Erik Gerdens Foundation, Sweden

    Berit and Carl-Johan Wettergrens Foundation, Sweden

    Available from: 2016-03-13 Created: 2016-03-13 Last updated: 2020-03-11Bibliographically approved
    3. Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach
    Open this publication in new window or tab >>Singing, sharing, soothing: Biopsychosocial rationales for parental infant directed singing in neonatal pain management: A theoretical approach
    2018 (English)In: Music & Science, ISSN 2059-2043, Vol. 1, p. 1-13Article in journal (Refereed) Published
    Abstract [en]

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

    Place, publisher, year, edition, pages
    Sage Publications, 2018
    Keywords
    Affect attunement, biopsychosocial, infant, infant-directed singing, music therapy, pain management, parent, vitality affects
    National Category
    Musicology
    Research subject
    Health and Medical Care Research
    Identifiers
    urn:nbn:se:oru:diva-67535 (URN)10.1177/2059204318780841 (DOI)
    Available from: 2018-06-27 Created: 2018-06-27 Last updated: 2019-11-19Bibliographically approved
    4. Development of family-centred care informing Nordic neonatal music therapy
    Open this publication in new window or tab >>Development of family-centred care informing Nordic neonatal music therapy
    2019 (English)In: Music in paediatric hospitals – Nordic perspectives / [ed] Lars Ole Bonde, Kjersti Johansson, Oslo: CREMAH, Norwegian Academy of Music , 2019, p. 1-25Chapter in book (Refereed)
    Abstract [en]

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

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

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

    Funding Agency:

    Centre for Clinical Research, Region Värmland, Karlstad, Sweden

    Available from: 2019-11-03 Created: 2019-11-03 Last updated: 2019-11-19Bibliographically approved
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  • 3.
    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)
  • 4.
    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)
  • 5.
    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.

  • 6.
    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.

  • 7.
    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)
  • 8.
    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)
  • 9.
    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
  • 10.
    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.

  • 11.
    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)
  • 12.
    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.

  • 13.
    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)
  • 14.
    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)
  • 15.
    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, 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.

  • 16.
    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.

  • 17.
    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.

  • 18.
    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.

  • 19.
    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.

  • 20.
    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)
  • 21.
    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.

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