Abstract
An inpatient stay at the hospital is often a stressful and scary time for patients and their loved ones accompanying them. Including art, particularly therapeutic music, may be a non-pharmacological way to improve the inpatient stay. This project evaluated the impact of an inpatient, musician-facilitated Therapeutic Bedside Music Program on the patient and caregiver experience via a post-survey of 176 therapeutic bedside music recipients. Recipients of therapeutic bedside music reported satisfying experiences and a desire for more music (31.75%). Specifically, they appreciated the musician facilitator (50%), experienced a calming and relaxing effect (44.90%), experienced joy (37.16%), and benefit during a stressful time (24.32%), and even perceived a positive impact on their physical healing (12.16%). Results of this project demonstrate a positive impact of facilitated therapeutic bedside music on care experience and demonstrate a need for research on the clinical impact of the program.
Plain Language Summary
Title
Project on playing therapeutic music at patients’ bedside during a hospital stay
Why was the project done?
A hospital stay can be stressful for the patient and their loved ones helping to care for them. Listening to music can be therapeutic and calming, but studies have not carefully assessed the impact of therapeutic music at the bedside during a patient hospital stay. This project evaluated the impact of an inpatient, artist-facilitated Therapeutic Bedside Music Program on the patient and caregiver experience.
What did the project team do?
Between November 2023 and February 2024, 176 people completed a brief survey after receiving therapeutic bedside music to give their feedback on how it impacted their experience of their hospital stay. In this program, bedside music includes a private concert for about 15 to 30 minutes with a trained therapeutic musician who usually plays harp or guitar.
What did the project team find?
People who received therapeutic bedside music and completed the survey said it was a satisfying experience, and many wanted more music (31.75%). Specifically, they appreciated the musician facilitator (50%), experienced a calming and relaxing effect (44.90%), experienced joy (37.16%), and benefit during a stressful time (24.32%), and even perceived a positive impact on their physical healing (12.16%).
What do the findings mean?
This project showed that therapeutic bedside music improves the patient and caregiver experience. Future projects should research the impact of therpauetic bedside music on clinical outcomes.
Introduction
In the inpatient hospital setting, the patient experience is commonly filled with stress not only due to the primary reason for hospitalization, but also due to the hospital environment. For example, while in the hospital, patients experience sleep deprivation, tube and line restrictions and concerns about finances. 1 Although many of these stressors are nonmodifiable, changes in the hospital environment can improve the care experience for patients and families. One environmental enhancement is music, which has been shown to positively influence patients and staff in a range of settings in the hospital including the preoperative and lobby areas. 1
Therapeutic music, which is the intentional use of music facilitated by a trained musician to enhance patient well-being and health outcomes, has become more prominent in healthcare.2,3 This is distinct from listening to music passively, because it includes a relational element between the patient and the music facilitator, and an immediate experience tailored to patient preferences. 4 Therapeutic music in healthcare can help patients build relationships, express difficult emotions, improve mood, enhance psychological health, and improve physical health (ie, hormone balance, improved heart rate, enhanced motor skills, brain stimulation).5–7 Despite growing evidence of the effectiveness of therapeutic music in the inpatient setting on improving the care experience, few hospitals have implemented or evaluated a therapeutic bedside music program.
Stanford Health Care is one example of a large academic medical center which offers a Therapeutic Bedside Music Program that employs a human-centered approach to improve the patient and family experience in the inpatient setting. Since 2013, the program has provided therapeutic music to more than 20,000 patients, their visitors, and staff annually. Therapeutic music facilitators are instructed to offer one-to-one companionship and support for patients and undergo site-specific training called Heart-to-Heart (see Appendix A) to orient them to the organization's overall Office of Patient Experience mission and values, encourage self-care and teamwork, and train skills for active listening and empathy. Although music alone can evoke strong positive emotions, 7 the interactions with a therapeutic musician foster a deeper connection with empathy, providing patients and their families with a space where they feel heard and acknowledged.
There are six bedside therapeutic musicians in the program. Three musicians are certified healing harpists, and three are guitarists. Their combined experience spans decades and includes additional certifications (ie, Harp for Healing, 8 and Music for Healing and Transition Program™ 9 ) which qualify them as experts in therapeutic music. All musicians in the program play a variety of genres including classical, rock, blues, jazz, and country, among others. They all know at least two songs in Spanish, which is the organization's most common non-English patient-preferred language. One musician speaks and can play music in Mandarin. Patients are invited to request a specific genre of music, and their request is granted whenever possible. Session lengths are tailored to the amount of support a patient or caregiver needs during scheduled rounds or by urgent request. However, most one-to-one therapeutic music sessions last 15 to 20 minutes, and end-of-life sessions for patients and their families often last up to a few hours. Patients often share the impact the program had on them with their music facilitator. However, no systematic assessment of program impact had occurred.
As such, this project adopts a phenomenological approach to evaluate the impact of the Stanford Health Care Therapeutic Bedside Music Program on the patient and family experience in the inpatient setting.
Methods
Recipients of therapeutic bedside music were adult patients in inpatient units. Services were offered to all patients through scheduled rounds and referral by self, clinical or other team members (ie, spiritual care or social services), or family (see Figure 1 for referral process). This process was created following a needs assessment in 2022 which revealed that patient self-referrals alone created barriers for certain groups of patients (ie, patients with limited English proficiency or in units affected by capacity constraints) to access services. As a result, scheduled unit rounds were implemented in each inpatient unit, and therapeutic musicians who spoke additional languages (ie, Spanish and Mandarin) were recruited.
Process for receiving therapeutic bedside music referrals.
For this quality improvement project (#74938), all patients and/or caregivers who were physically able to complete a voluntary, anonymous, electronic 5-minute post-survey about their experience of therapeutic bedside music were invited to participate. Patients who were unable to complete the survey due to their clinical status were excluded. All patients could opt out of services and/or the survey. Surveys were collected between November 2023 and February 2024. The facilitator invited recipients via a QR code to complete the post-survey in Qualtrics.
Survey questions were reviewed and revised with the Patient Experience Analytics and Reporting Team, then further developed with the second author. Surveys began by asking about the respondent's relationship to the patient. Subsequent questions asked recipients how likely they were to recommend the Therapeutic Bedside Music Program, and if the program impacted their experience. If yes, recipients were asked two open-ended questions which read, “What did you experience?” and “Please let us know if you have any additional comments about the program that will help continue to make this program great for other patients!”
All survey responses were exported into Excel. A phenomenological approach was adopted for qualitative analysis to focus on music recipient experience. Qualitative responses were read and organized into themes inductively by both authors and an organizational Secure GPT. The Secure GPT used is HIPAA secure, and only available to employees of the organization by accessing the GPT with their unique login on an encrypted, organization-issued device. Themes generated by each author and Secure GPT were finalized via consensus. Both authors manually coded data into themes, and calculated theme frequencies with intercoder reliability. The authors maintained reflexive notes throughout the analysis process and met regularly to ensure rigor. Each response could be coded into multiple themes. Coding for themes generated in the analysis were considered reliable with over 90% agreement. Findings were triangulated via review by several Therapeutic Bedside Music Program facilitators who agreed that the results accurately represented their observations of music recipients’ experiences.
Results
From November 2023 to February 2024, 4891 patients received therapeutic bedside music. Of these recipients 3.6% (
Qualitative analyses resulted in five themes for music recipients’ description of the Therapeutic Bedside Music Program's impact on their experience. See Table 1 for a summary of themes and exemplar quotes. Half of recipients stated deep appreciation for the music and musician facilitator. Almost half of respondents (44.90%) reported experiencing a soothing and calming effect, aiding in relaxation during their hospital stay. Many respondents (37.16%) described their experience as uplifting, contributing to happiness and as a highlight during their day. Respondents also described the music as a benefit during a stressful time (24.32%) such as a positive distraction, comfort, or entertainment during challenging times in the hospital. Lastly, some recipients (12.16%) perceived a positive therapeutic impact on healing, alluding to a positive clinical impact of the music.
Summary of Themes.
Discussion
This project evaluated the impact of a Therapeutic Bedside Music Program in the inpatient setting. Results demonstrate that this program improves the care experience and may improve healing. Recipients reported an overall appreciation for the program and desire for increased music offerings. They also reported experiencing greater joy and stress relief. These results align with previous research on the impact of music for improving mood.5,7
Although music-based interventions can promote general well-being, they lack the defined therapeutic framework and goals that characterize formal therapeutic practices. 8 Results of this project add to the growing body of literature on therapeutic music in the healthcare setting which show positive impact of the one-to-one, immediate and patient-preferred music that facilitated therapeutic music provides. 10
Limitations
Our project had limitations. We solicited a convenience sample of able volunteers. Response rates were low, and we did not collect demographic information. Using survey methods excluded many potential participants as their clinical status rendered them unable to complete a survey. As such, findings reported here are not representative of the overall patient population. Similarly, information about the style or genre of music played was not collected and results do not reflect differences in music style. Given promising results from this project, future research should explore implications of bedside music for diverse patient populations, including Indigenous patients, use diverse methods for a larger sample, and explore impacts of different music styles.
Footnotes
Acknowledgements
The authors would like to acknowledge the Stanford Health Care Therapeutic Bedside Music facilitators for their talents and passions they bring to perform for patients, families, and staff. They also acknowledge the Stanford Health Care inpatient clinical team, Stanford Health Care Patient Experience Leadership and the Patient Experience Reporting and Analytics Team for their support in making this project possible.
Author Contribution
Declaration of Conflicting Interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical Statement
This initiative was deemed a Quality Improvement project by the Stanford University IRB (#74938). As such, no consent was required, and we are permitted to publish it. However, this work should be referred to as a project or initiative.
Appendix A: Heart-to-Heart Training Components
During onboarding and within the first 6 months of employment, therapeutic musicians are trained in and practice the following:
Observation and Reflection: Facilitators engage in observing practices and reflecting on their experiences with patients and in their own lives to enhance their skills. Introspective and Guided Reflection: Facilitators participate in both personal and guided reflection sessions with the Creative and Healing Arts Manager to deepen their understanding of their roles and the impact of their work. Self-Care and Coping Coaching: Training includes strategies for self-care and coping mechanisms to prevent burnout and effectively manage challenging interactions.
The Heart-to-Heart training also emphasizes the importance of fostering a strong team culture with fellow musician colleagues which includes:
Team Morale: Building a supportive environment that boosts team spirit. Shared Vision: Cultivating a collective understanding of the team's goals and values, with a particular focus on the organization's key goals and strategies in the Patient Experience domain. Team “Heartbeat”: Encouraging open communication and connection among team members.