Nijole Hunter, RN

Editors Note: If you like this topic, you can also listen to The Hospice Chaplaincy Show’s interviews with music therapists Jen Conley and Victoria Storm.

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In my work as a nurse, I occasionally encounter experiences that are eye opening. This was one of those. In mid March, to help limit the spread of covid-19, most skilled nursing facilities and in-service hospice homes like the one I work for refused visitors. Because we care for a very vulnerable population, it made sense to limit exposing our patients to the virus.

While these visit limitations, were extremely hard for the families of our patients, it was also harder for the patients themselves as they missed their loved ones.

One day, one of the sons of our patients broke the shelter in place recommendations to come to the facility to visit with his dying father. Just to see him for one last time and say his ‘goodbyes‘. To be honest, I would have done the same. The facility leadership was understanding enough to let him briefly visit his father. The visit only lasted about 15 minutes, although the patient was nonresponsive, this visit meant a lot to the son.

For those who are not familiar with the dying process, as patients make the transition from this world to the next, they become difficult to arouse, may appear comatose and do not respond to verbal or environmental stimuli. This inability to react to environmental stimuli is called nonresponsiveness.

Non-responsiveness is a characteristic that can be found not only in patients experiencing the end-of-life process, but also in patients experiencing different stages of Alzheimer’s Disease, comas, and low-awareness states. Although we have no way of knowing what non-responsive patients hear, experience indicates that their level of awareness may be greater than their ability to respond; therefore, it is wise to presume that the unconscious, or non-responsive patient, is hearing everything (EPEC, 1999).

After the son left, I went to the room to check on the patient. The son had left a note for me to turn on the music player at a specific time. To be honest, I love music, but I had never researched its therapeutic value to dying patients. That was personally eye opening for me. Previously, I had seen music therapists often come to the facility but didn’t make much of it. So, I began to research on the impact of music in end of life care and that’s what led to me writing this article.

I found that, individuals who are experiencing the end stages of life are usually able to process aurally, and, therefore, benefit from music therapy.

Music therapy is an evidenced-based intervention method that has been utilized with individuals and families at all phases of the dying process. Music therapy helps: to reduce stress, depression and anxiety, to increase relaxation and reality orientation, to provide a means of communication and self-expression, to offer procedural support, and to address issues of anticipatory grief (Starr, 1999).

Our brains are made from brain cells called neurons. These brain cells can be altered by external stimuli like music. When the sound of music enters the inner ear to the different parts of the brain. The right part of the brain is automatically triggered. That right hemisphere controls attention, thinking, communication and emotions.

Because it is widely agreed that the music center of the brain is often the last to deteriorate (Starr, 1999), this finding further validates the use of music therapy as an appropriate method of care for non-responsive patients. Music has the ability to elicit strong emotions and memories by offering a means of communication and by promoting mental awareness and physical activity. Soothing music provides a boost of oxytocin, which increases bond and trust.     

“When you hear music at your favored rhythm, the areas of your brain that control movement become more excited, making you more likely to start tapping your feet or moving along to it,” explains Martin Wiener, Ph.D., a psychologist at George Mason.

I was even able to see involuntary movements made by the patient’s feet. I shared that with the family and they were happy.  Musical rhythm is close to our life rhythms, like heartbeat, breathing, marching, and biological rhythms. Naturally, music can influence movement.

So, music is beneficial for any patient, no matter how he/she is affected by the disease. It is a complementary approach to help restore function loss and it is a pleasurable and enjoyable.

When stroke patients in Finland listened to music for a couple of hours each day, verbal memory and attention span improved significantly compared to patients who received no musical stimulation, or who listened only to stories read out loud. (www.sciencedaily.com/releases/2008/02.)

Likable music releases dopamine, a pleasure hormone which can improve pumping strength of the heart, helping blood to flow to the kidneys. Therefore, music is not just a combination of the sounds it is a powerful therapeutic tool. So, what’s music got to do with it? a lot!!!