Collaboration in Medical Music Therapy

One of the unexpected blessings from all that has occurred over the past year has been the amount of time to myself. I’m not talking about the time spent self-quarantining. I’m talking about the number of months I’ve been able to independently return to the roots of music therapy. There are always unexpected benefits to being forced to stop and reduce your load – even if that wouldn’t be your first choice in the moment. The primary responsibility that was suddenly removed from my workload a year ago was serving as an internship supervisor. Much of my day-to-day work for the last few years has been in providing supervision and training to interns, often overlapping in timelines and set on a fairly continuous loop. With our internship indeterminably paused, I suddenly found myself with so. much. time. I thoroughly enjoy having interns, but when an intern is constantly at your side, many professional opportunities and experiences either get missed or given to the student. One of these opportunities was in building new or stronger relationships with other disciplines at our hospital and co-treating frequently.

My personal philosophy of music therapy is that it works best in conjunction with others; whether that is the client themselves, a family, or a treatment team. At our hospital, we strive to offer our interns as many opportunities as possible to co-treat with our incredibly diverse multidisciplinary team. One of the drawbacks to this however, is that interns are still learning. When you have newbies leading the way, co-treating doesn’t always go the way it was expected. We are incredibly lucky to be a teaching hospital where the majority of the staff enjoy teaching others and are therefore incredibly patient. Not to mention, our incredibly gracious patients and families.

For the first time in awhile, co-treating returned to it’s stablest collaboration between professionals. Suddenly, I was making frequent morning calls to set up scheduled times to work with different disciplines in our collaborative approaches to patient care. Many times these calls led to a domino affect where Physical Therapy (PT) might have coordinated with Occupational Therapy (OT), and OT wanted me to overlap with PT, but before Child Life (CL), and after Respiratory Therapy (RT). But don’t forget that the Hospital Schoolteacher (HST) needs to connect with the patient and family after the medical team has rounded and before PT begins. If that sounds like a pretty packed schedule for a pediatric patient it certainly is, but that is a normal day in much of the hospital setting. What is particularly powerful about this series of events is that music therapy belongs. It is not the afterthought discipline that squeezes in somewhere, but is instead a thoughtfully planned part of the treatment plan for the day.

So, how do you jump from being a brand-new team member, trying to advocate for the start of a program to being a called, consulted, and scheduled part of the treatment team?

By building relationships.

Part 1: Music Therapy and Nursing

If you were to prioritize any particular relationship to build in the hospital setting, it should definitely start with your nurses. Just like with any other field or discipline, certain types of personalities are drawn to different areas of the hospital. Certain specialities and acuities require unique skillsets. Figuring out what types of people are drawn to certain units/clinical areas is a great first place to start in determining each unit’s culture. For example, it is probably not surprising to learn that nurses in the neonatal intensive care unit are extremely protective. They care deeply about their babies and care for them with such gentleness and compassion it is as if they these babies are their own. Unsurprisingly, they can take a bit of convincing that their baby will not experience harm when left in the hands of others.

Nurses notice the details and the medical team looks to them for the ins and outs for how their patients are responding. Nurses are strong advocates. If something is not right with their patient, they speak up. They call; they inquire; they resolve. They take pride in their patients’ successes and they grieve for the challenges and losses. Nurses lessen their boundaries so that their patients feel comfortable knowing who is taking care of them so intimately.

Nurses can become your number one fan – but only after they witness and experience the complexity and dedication of your work. Nurses are not going out of their way to skeptically question you or prevent you from doing your job. They are protecting their patient. Instead of providing education about what you are there to do with your patient, ask them how they think the patient is doing. What have they noticed? What could the patient benefit more from? What do they think the patient needs right now? Incorporate the nurses’ perspective and expertise into your advocacy for utilizing music therapy with this patient.

Invite the nursing staff in. Offer to help them with whatever they were planning to do with the patient rather than immediately promoting your goals/objectives. One of my favorite ways to collaborate with nursing in the NICU particularly is assisting with hands-on-care. At scheduled times of the day, nurses provide all of their care at once to limit the amount of times the infant is touched, stimulated, and prevented from sleep. Wonder why a nurse seems annoyed that you are providing music therapy at this time? Perhaps it’s because you came 30 minutes after hands-on-care was completed and now the baby has been prevented from a nap. Much of NICU music therapy can be provided in collaboration with hands-on-care – even if that means you are singing to a baby while their diaper is changed, dressings are changed, sites are cleaned, etc. How does music therapy help during hands-on time? How often does hands-on care become so much less stressful for baby and nurse because MT was there to support everyone?

What else is great about this collaborative time, you might now be asking? More often than not, there are clinical situations that come up unexpectedly that allow you and the nurse to bond. Just a few weeks ago, I was providing support during hands-on when an infant’s gastrostomy (g)-tube fell out. That’s right – it just simply fell out. The nurse was really caught off guard and had my extra two hands not been there already providing hand-over-hand movement with baby to “The Itsy Bitsy Spider,” the situation would have been even messier than it already was. I ended up providing assistance for an additional half hour to this nurse who otherwise would have been scrambling for help or to complete everything independently, but all the more stressfully. Now, this particular nurse and I have this story as a shared moment that we have referenced since then and have a stronger association with one another.

Ultimately, we have shared memories that have started a foundation for a relationship.

We are all humans, regardless of our discipline and our training. Oftentimes the medical setting is incredibly intimidating – especially for new music therapists or those new to this population. I have found that the best advocates for music therapy in the hospital setting are those who have directly felt their own work supported and have been able to witness the positive responses because of the collaboration. Additionally, get to know them for more than just their nursing work and share details about yourself. When nurses know you as a person, it is so much harder for them to decline your advocacy or rationale for the work you plan to do with their patient. They trust you as a person and therefore will trust you to also take care of their patient.

But don’t worry – if you need them, they will only be in the room next door.

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