Palliative Care – Part 2
Interestingly, Johnson et al. (2006) considered spiritual health as an overall implication for anyone involved in palliative care which in this case involves the nurses. This then confirms Desbiens et al. (2007) study that relates to the nurses coping strategies. Even though Johnson et al. (2006) studys main focus was not spiritual, the study done stressed the importance of having a holistic approach as mentioned in the background.
It was indicated that, other studies should be aware of palliative cares incorporation of all perspectives which include: psychological, social, physical, existential and spiritual. Surprisingly all the studies discussed in this paper that relate to spirituality actually used at least one concept of what Johnson et al. (2006) discussed mentioned in his research the negative part is that none of the studies focused on all the aspects that he mentioned.
Kernoham et al. (2006) discovered that spiritual issues which required support was rated as important to the participants lives and was psychological and social in nature, this information is supported in Johnson et al. (2006) background information. In Kernoham et al. (2006) study, spirituality was perceived to be a broad concept that was expressed both humanistically and religiously. 82% of the people in the study who received chaplaincy services felt that their spiritual needs were addressed and they had positive feedback on the services received. In the study only 28 out of 49 people remembered ever receiving the chaplaincy information leaflet while the chaplain identified the spiritual needs of only 44 participants as being met, rather than the actual number of 52 patients. These inconsistencies rooted to the limitations. Unlike Kernoham et al. (2006) study which focused on spirituality, Wlodarczyk (2007) focused on spirituality and music. The study posed that music therapy interventions such as songwriting, music-guided life review and providing opportunity for worship resulted in spiritual exploration and support. In Wlodarczyk study it was noted that the participants, requested for spiritual music in 75% of the music visits, and they preferred this to the discussion of spirituality without music. Spirituality issues were discussed 35% of the music visits as opposed to 15% of the non-music visits. In the case of Wlodarczyk (2007) spiritual music had a great impact on spirituality itself because the patients were actually more than likely to express themselves spiritually in the presence of music thus indicating that music helped stimulate peoples thoughts about certain issues. This may answer the question of inconsistencies addressed by Kernoham et al. (2006) study that revealed that only 28 out of 49 people remembered ever receiving the chaplaincy information leaflet. If these patients had experienced spiritual music rather than the information provided to them, they would have, more than likely been able to remember the spiritual information associated with the information leaflet. Overall, most patients in Kernoham et al. (2006) study viewed spiritual care to be essential to healthcare despite the inconsistencies that were reported.
The purpose of music in the research done by Evans (2002) was to determine whether music would help reduce anxiety and pain, minimize physiological consequences of pain in unpleasant procedures and situations or increase satisfaction with care. Evans (2002) target was the patients themselves. In contrast O'Kelly and Koffman (2007), aimed to explore the role of music therapy within multidisplinary palliative care teams and to guide both service providers and music therapist on the future integration of music therapy in palliative care. The questions and prompts used in the interview focused on the previous experiences of the participants who were music therapists from five United Kingdom (UK) hospices. The main focus was their music therapy work, their perception of the scope of music therapy in palliative care, and on the factors that they thought contributed to supporting or inhibiting the integration of music therapy within different disciplines involved palliative care.
While O' Kelly et al. (2007) study was directed to the multidisplinary palliative care teams perspectives, Evans (2002) reviewed all the evidence- based materials from a patients perspective. These studies proved to be very important because O' Kelly et al. (2007) found out that music therapy was very valuable to most interviewees. Unfortunately, the role of the music therapy was not understood among nurses. The study further discovered that music therapy had an impact on ones physical, emotional, social, environmental, creative, and spiritual health when provided with other disciplines also supporting Johnson et al. background information. Evans (2002) on the other hand, discovered that Music used in patients during hospitalization showed a reduction of anxiety and an improvement on mood during normal care delivery. Music however, had no impact on those receiving invasive or unpleasant procedures nor did it have an impact on their heart rate. There was also limited evidence that supported the use of music to reduce the need for sedation and analgesia during procedures.
The main limitation that was focused in the studies done by Evans (2002) and O'Kelly et al. (2007) was that they both provided partial insights into music therapy and they recommended follow-up studies to make sure that their studies became more valid. Since music therapy was not understood by many nurses in O' Kelly et al.(2007) study, this could explain the reason why many patients did not observe any impact on the study done by Evans (2002) because they had never been exposed to music therapeutically as a means of coping with their symptoms in a hospital setting.
In reviewing the literatures on the topics of spirituality and music, I found out that Spirituality was explained as being important not only to the patients but also to the nurses who provided care to those receiving palliative care. Nurses also used spirituality to help them with their coping skills during bereavement after their patients passing. The spirituality of the nurses seemed to affect the way they treated their clients because the nurses addressed the clients quality of life and dignified death thus approaching spirituality indirectly.
Music helps people when they are anxious or in unpleasant situations by relaxing them or diverting their attention to the words or different sounds from the music. Music is used spiritually to convey different messages to the listener, for praise, prayer and meditation among others. Music and spirituality go hand in hand when it comes to exploring peoples inner emotions, meaning of life and in unexplained circumstances like in palliative care. I was disappointed to find out that the nurses appeared to have less experience in music therapy and its benefits in their patients. Music was also the least explored by studies and most of the studies done stressed the importance of having more studies that looked into the whole insight of music and its benefits and on education of music among nurses. The only people who knew the benefits of music therapy were the music therapists themselves.
In conclusion, am glad to state that there is a connection in spirituality and music in palliative care when addressing peoples emotions, spiritual needs and quality of life as reported by Wlodarczyk (2007). It is important to note that people actually do relate their spiritual experiences to spiritual music and they tend to express themselves more when music is presented with spiritual information. References:
Desbiens, J.-F., & Fillion, L. (2007). Coping strategies, emotional outcomes and spiritual quality of life in palliative care nurses. International Journal of Palliative Nursing, 13(6), 291-300.Evans, D. (2002). Effectiveness of music as an intervention for hospital patients: a systematic review. Journal of Advanced Nursing, 37(1), 8-18.Johnson, B., & Smith, L.N. (2006). Nurses and patients perceptions of expert palliative nursing care. Journal of Advanced Nursing. 54(6), 700-709.Kernoham, G., Waldron, M., McAfee, C., Cochrane, B., & Hasson, F. (2007). An Evidence base for palliative care chaplaincy service in Northern Ireland. Palliative Medicine, 21, 519-525O'Kelly, J., & Koffman, J. (2007). Multidisplinary perspectives of music therapy in adult Palliative care. Palliative Medicine, 21, 235-241.Wlodarczyk, N. (2007). The effect of music therapy on the spirituality of persons in an In-patient hospice unit as measured by self-report. Journal of Music Therapy. XLIV (2), 113-122.