Let There Be Love – The impact of Wellspring live music in hospitals in the UK
Dr Anneli Haake
This report evaluates the impact of live music in two hospitals in Nottingham, UK, as provided by Wellspring Music CIC. Observations and surveys showed positive responses among patients, which were also in line with what staff and visitors reported. The staff reported increased wellbeing as a result of the music sessions, and similar patterns were found among visitors and family members.
The results suggest that music can create a space for patients in hospital to interact, connect and ease their anxiety and stress, and that such music activities can also support healthcare staff in their working environment by providing entertainment, relaxation and help bringing a level of normality and everyday life into the hospital wards.
The evaluation study
An evaluation study was carried out in 2018, in order to capture and assess evidence of the impact of Wellspring’s music activities at Queen’s Medical Centre and City Hospital in Nottingham, UK. Observations (both quantitative and qualitative), surveys and some brief interviews were conducted. The data collection instruments and the topic guides for interviews were designed and developed by Dr Anneli Haake (evaluation consultant). Quantitative and qualitative data was collected with consent on 8 occasions in Nottingham during 2018 (September-October). Observations, surveys and interviews assessed the impact on patients, their families and the hospital staff. For more information on evaluation methodology please refer to the appendix.
The units selected for evaluation purposes were the wards where Wellspring undertook their music activities: two critical care wards, one surgical ward, three elderly wards, one dementia ward and three stroke wards. These wards all included a variety of rooms and spaces available, including multi-bed bays and single rooms. The ward visits lasted around 5 hours in total per day per site. Wellspring performed at individual patient bedsides as well as in bays with multiple patients in the same space. The nature of the impact and the engagement between the musicians and patients, staff and visitors varied according to the setting. The medical staff and support staff sometimes directed the musicians to certain patients that they felt could specifically benefit from musical interaction.
The musicians make a massive difference – especially for our patients
who are very bored + have been here for a long time.
Also great at calming + distracting our dementia patients.
In response to the survey, the majority of health care staff agreed or strongly agreed that Wellspring’s music activity reduced patients’ anxiety and isolation, that it increased patient self-expression and staff wellbeing, and that there should be more of this activity available.
This seems to correspond to the results from the observed indicators, which showed signs of all indicators at varying degrees, including enjoyment, relaxation, engagement, participation and various types of interactions between patients and others at the hospital.
The following sections present the results from the view of the outcomes in the evaluation; i) music activities as a way to reduce anxiety (indicators enjoyment, relaxation and engagement), ii) music as a way to reduce isolation (interaction indicators and staff joining in), and iii) music as a way to increase self-expression (indicator participation).
Music activities as a way to reduce anxiety
During the observations, 82% of the patients observed showed clear signs of enjoyment. They demonstrated this by smiling, telling the musicians how the music activities cheered them up, clapping their hands, being interested in the musicians and their instruments, and nodding along with the music. When comparing the wards, the elderly wards and the dementia ward showed a similar level of enjoyment (78% and 77% respectively) whereas 73% of critical care patients and 94% of stroke patients showed clear signs of enjoyment.
Patient nods head to music, taps feet, singing along, recognising song, waves arms. “I’ve never heard music like this in a hospital. I’ll tell me wife when she comes in. It’s lovely, it brightens the place up a bit”
(Observer notes, stroke ward, October 2018)
Patients well enough to speak commented often and said things like “I really enjoyed that”, “That’s cheered me right up this morning. Was fed up”, “come again”, “beautiful”, and “thank you”. Staff said in their survey that they saw patients “happy”, “smiling”, “delighted” and “amused”, and visitors commented that the music had “perked” their relatives up, and that the patients had reacted with “joy” and the music had “made them smile”.
Many of the patients observed also showed signs of relaxation (65%). They closed their eyes when listening to the music, showed physical signs of relaxation (dropped their shoulders, started breathing more slowly, relaxed their faces, and sometimes falling asleep) and occasionally cried in response to the music. Critical care patients and stroke patients showed the highest levels of relaxation (89% and 95% respectively), while 45% of patients on elderly wards and, similarly, 45% of dementia care patients showed signs of relaxation. One of the observers in the Critical Care ward noticed that one patient had systolic blood pressure of 149 when the musicians began playing, and it was 130 when they left.
Staff commented that the music was “very relaxing” and “peaceful” for the patients, and that music can be a “distraction from pain” and also bring out “powerful memories”. One visitor stated that “it brought CALM before her [the patient’s] op!”. The fact that some patients did not display relaxation indicators does not necessarily mean that they did not enjoy or engage in the music session. It just simply means that they did not display these particular indicators.
A majority of the patients observed (62%) also engaged in the music activities in some way, such as maintaining strong eye contact with the musicians, showing appreciation (for ex clapping when the music stopped and talking to the musicians), tapping fingers and moving their feet and toes, nodding their heads and swaying their bodies to the music. In critical care and the elderly wards, around 50% engaged in the music activities, whereas 65% of dementia care patients and 82% of the stroke patients showed signs of engagement.
Patient says “you’re going to make me cry”, patient closes eyes while music playing, tears – patient struggles to wipe his eyes, tries hard to clap at the end. Patient appeared more alert throughout the music session compared to when we entered the room. Said “I like that”. Appears to take a great deal of effort to talk to musicians. Tells nurse “when I close my eyes, I AM still listening”. Nurse says “are you enjoying the music?” Stands next to patient’s bedside to share experience with him. She said his heart rate went down and it makes him calmer when music is playing. Nurse tells patient “I really enjoyed that, I always do”, “it made you more relaxed and calm. Said to musicians “I think you are amazing”.
(Observer notes, Critical Care Ward, October 2018)
Both visitors and staff provided a wealth of feedback with many examples of how the music sessions had lifted the spirits of patients and made them more relaxed, and sometimes also provided emotional release. Wellspring regularly receives feedback on their Facebook page and on their website. One example of many was recently posted on their website:
I visited my dad in QMC yesterday. I was held up in traffic so I had just missed you on B47, yellow bay. Dad cried because he had loved you being there and I hadn’t been there to share it. You played ‘Ring of Fire’ with him and it reminded him of my mum. He was talking about you all afternoon whilst I was with him. He loved it and it really cheered him up. Thank you. Carry on the good work.
Music as a way to reduce isolation
The music sessions provided several ways for patients to interact and make contact with others. In the observations, interaction between musicians and patients were detected most often (66% of the time). The observed patients demonstrated this by having eye contact with the musicians, speaking to them, smiling at them, nodding at them, and engaging with them.
Sometimes they beckoned the musicians to come over to them, reaching towards them and occasionally touching them (held their hands for example) or giving them a hug.
Patient hold hands up as if to beckon musicians. Appears to have difficulty with speech but says “wonderful”. Patient smiling, asking for musicians to come closer. Patient looking at visitor and both smiling. Patient using shaker in time to music. When musicians move away to make way for phlebotomist, patient beckons them to come closer when she has finished. Nurse attending to patient sways body slightly and says to patient “very nice music” as she does his blood pressure (appears to use music as a form of distraction). Patient’s visitor (2 of them) appeared pleased that he was listening to musicians “it’s so lovely of you, I think it’s fabulous”. Patient singing. Visitors took a photo of patient with musicians. Patient became very animated throughout session. High levels of engagement between patient and visitors as a result of music. Visitors nodding head, tapping fingers at patient’s chair, swaying + dancing on the spot, singing + smiling + clapping. Patient leans forward and hugs musicians.
(Observer notes, Critical Care, October 2018)
Patients often engaged in conversation with the musicians, about the repertoire (and sometimes made requests for particular songs) and about the musicians’ instruments. But we also observed some patients opening up to the musicians, telling them about their earlier lives, what the music reminded them of, and of their current circumstances and health status.
Patient animated, talking about music “I like all sorts of music”, tapping feet, swaying, singing, talking to musicians about seeing musicians perform in Nottingham (Buddy Holly, Beatles), talked to Patient 3.
At the end: “I really enjoyed that, thank you”
(Observer notes, Dementia ward, October 2018)
The music sessions often facilitated extra contact between staff and patients, where members of staff seemed to enjoy watching the patients reacting to the music. Staff and patients sometimes talked about music together. Members of staff often showed clear signs of joining in on the music activities. They sang along, clicked their fingers, nodded their heads, tapped their fingers, and some danced and sang in front of the patients. Staff generally seemed to welcome the musicians, and many talked about how much they loved the day of the week when the musicians were there. Staff also stated in the surveys how the music sessions had a direct impact on them. The music made their working environment calmer, and sometimes created a space for them to get on with their work.
The patients look forward to hearing the musicians. We have seen some very touching moments where the family have seen glimpses of their relatives reacting to the music as if they were back to their old selves. There have been touching moments where family and staff are crying as the musicians play favourite music of patient on end of life care.
The music therapy is an important part of the care our patients receive.
(Health Care Assistant, dementia ward, October 2018)
In the majority of the wards, the patients did not have any visitors when they were observed (on 227 occasions). On the occasions when the patients did have visitors and were observed, the music sessions facilitated interaction between patients and their visitors 82% of the time. This was demonstrated by eye contact, loving touch, engaging in the music together, and talking about the music and reminiscing afterwards. One of the visitors commented that the music “gave us things to talk about, opened things up. She told me about meeting her husband.”
The least observed type of interaction was interaction between patients. Sometimes this was not at all possible, due to physical barriers (single rooms, curtains drawn, etc) or due to health conditions, but where it was spatially possible for patients to interact, we observed this type of interaction 15% of the time. This included smiles and nods towards each other, eye contact, and also conversation that either began or continued as the musicians left the room.
Music as a way to increase self-expression
Overall, 36% of the observed patients actively participated in the music activities. This included singing along (or mouthing words), playing instruments (for example shakers or xylophone), dancing and clapping hands in time to music. 60% did not actively participate.
Patient smiling, nodding head, crying, singing along, took shaker and shook it in time to music to Jungle Book song, touching shaker to Marc’s shaker, talking to Marc about music, talked about playing guitar.
Said “it brought my vitality back”
(Observer note, dementia ward, October 2018)
Some patients were not well enough to sing, dance or hold instruments, so this is to be expected in a hospital setting. The wards that had the highest levels of participation were the stroke wards where 60% participated in music activities, compared to critical care (30%), elderly wards (24%) and the dementia ward (31%). Even though not all patients were able to, or were unwilling to, participate in the music activities, it was clear from the observations that those who did participate really enjoyed it and that it meant a lot to them.
The results suggest that music helped to reduce anxiety in patients, reduce isolation and increase some patients’ self-expression. Patients showed clear signs of enjoyment, relaxation and engagement. They also interacted with the musicians, with visitors (when they were present), with staff and occasionally also with each other.
Likewise, visitors and hospital staff enjoyed the music activities. The most commonly described positive effects were enjoyment, happiness and relaxation. Visitors and staff also reported “enjoyment by proxy”, where they enjoyed watching the patients enjoying the music activity and subsequently experiencing positive feelings as a result. The majority of the hospital staff enjoyed the music for their own sake too. They did not report feeling distracted from their work; instead they often enjoyed it and participated in the music activities.
It is important to point out that while music in hospitals cannot replace any of the medical care provided in hospitals, it is a relatively cost-effective activity that can give a sense of wellbeing for everyone on the wards, as confirmed by this evaluation and by previous research. During a 5-hour visit, Wellspring can potentially reach up to 40 patients, and more than 30 healthcare staff.