Psychological health in Palliative Care: Thematic analysis of a psychiatrist's and an art therapist's clinical reflexive journals

BACKGROUND

Patients receiving palliative care often face psychological distress, which can be challenging for clinicians to manage. Therefore, reflexive and visual journaling can be used as powerful techniques for clinician selfreflection and personal development. These journals are a form of practice wisdom, providing insights into psychological health in palliative care.

AIM

This study aims to describe how patients receiving palliative care experience psychological health, explore the meaning of a palliative care clinician's work and contribute to the understanding of psychological health in palliative care through the reflexive and visual journals of clinicians.

DESIGN

Using Gibb's reflective cycle as a framework for journaling, this study employs reflexive and visual journaling through the lenses of a psychiatrist and an art therapist. Journal data were analysed using a thematic analysis approach.

SETTING/PARTICIPANTS

The two first authors journaled 107 clinical encounters and created 36 pieces of response art detailing encounters with patients and their families, and clinical conversations in two palliative care centres.

RESULTS

Patient attributes and the clinical environment were observed to influence psychological health in palliative care. The patient's ability to navigate dying, maintain personhood, exert resilience and experience satisfying relationships contribute to psychological health. A clinical environment comprising clinicians with holistic competencies, systems promoting interdisciplinary collaborations and a values-based culture that promotes patient centricity strengthens the delivery of psychological care.

CONCLUSIONS

Good psychological health in palliative care extends beyond psychopathology and is influenced by the cardinal elements of being human, value systems and systemic elements in the therapeutic environment.

Dealing with Palliative Care Patients’ Incomplete Music Therapy Legacies: Reflexive Group Supervision Research

Legacies encompass treasured memories and items such as wills, publications, and songs, which help to validate lives. Legacy creation is encouraged by palliative care staff to help patients deal with loss and find personal meaning; the legacy works may also support the bereaved. Within the literature, however, there is no consideration of how staff deal with patients’ incomplete legacies when patients relocate, deteriorate, or die. Our research focuses on this question: What experiences did four music therapists have with palliative care patients’ incomplete tangible music therapy legacies? Data included transcripts from the therapists’ discussions about patients’ incomplete legacies in three reflexive group supervision sessions and further reflections written during transcript verification. Inductive thematic analysis yielded five themes: the nature of incomplete music therapy legacies; reasons for and feelings about these legacies; factors determining what music therapists do with them; considerations about their future “life”; and the ways therapists’ shared reflections can support their future legacy work.

"Life Within the Person Comes to The Fore": Pastoral Workers' Practice Wisdom on Using Arts in Palliative Care

BACKGROUND

Pastoral care (also chaplaincy, spiritual care) assists people to find meaning, personal resources, and connection with self, others, and/or a higher power. Although essential in palliative care, there remains limited examination of what pastoral workers do. This study examined how pastoral workers use and consider the usefulness of art-based modalities.

METHODS

Qualitative research was used to examine the practice wisdom (tacit practice knowledge) of pastoral workers experienced in using visual arts and music in palliative care. Two focus groups were conducted. Thematic analysis was informed by grounded theory.

RESULTS

Six pastoral workers shared information. Three themes emerged. First, pastoral workers use arts as "another tool" to extend scope of practice by assisting patients and families to symbolically and more deeply contemplate what they find "sacred." Second, pastoral workers' art affinities inform their aims, assessments, and interactions. Third, pastoral workers perceive that art-based modalities can validate, enlighten, and transform patients and families through enabling them to "multisensorially" (through many senses) feel recognized, accepted, empowered, and/or close to God. Key elements involved in the work's transformative effects include enabling beauty, ritual, and the sense of "home" being heard, and legacy creation.

DISCUSSION AND CONCLUSION

Pastoral workers interpret that offering art-based modalities in palliative care can help patients and families to symbolically deal with painful memories and experiences, creatively engage with that deemed significant, and/or encounter a sense of transcendence. Training in generalist art-based care needs to be offered in pastoral education.

Speech vs. singing: infants choose happier sounds

Infants prefer speech to non-vocal sounds and to non-human vocalizations, and they prefer happy-sounding speech to neutral speech. They also exhibit an interest in singing, but there is little knowledge of their relative interest in speech and singing. The present study explored infants' attention to unfamiliar audio samples of speech and singing. In Experiment 1, infants 4-13 months of age were exposed to happy-sounding infant-directed speech vs. hummed lullabies by the same woman. They listened significantly longer to the speech, which had considerably greater acoustic variability and expressiveness, than to the lullabies. In Experiment 2, infants of comparable age who heard the lyrics of a Turkish children's song spoken vs. sung in a joyful/happy manner did not exhibit differential listening. Infants in Experiment 3 heard the happily sung lyrics of the Turkish children's song vs. a version that was spoken in an adult-directed or affectively neutral manner. They listened significantly longer to the sung version. Overall, happy voice quality rather than vocal mode (speech or singing) was the principal contributor to infant attention, regardless of age.

Sound continuing bonds with the deceased: the relevance of music, including preloss music therapy, for eight bereaved caregivers

This study examines music's relevance, including preloss music therapy, for 8 informal caregivers of people who died from cancer. The design was informed by constructivist grounded theory and included semistructured interviews. Bereaved caregivers were supported or occasionally challenged as their musical lives enabled a connection with the deceased. Music was often still used to improve mood and sometimes used to confront grief. Specific music, however, was sometimes avoided to minimize sadness. Continuing bonds theory's focus on connecting with the deceased through memory and imagery engagement may expand to encompass musical memories, reworking the meaning of familiar music, and discovering new music related to the deceased. Preloss music involvement, including music therapy, between dying patients and families can help in bereavement.

Music's relevance for children with cancer: music therapists' qualitative clinical data-mining research

Music is central in most children's lives. Understanding its relevance will advance efficacious pediatric supportive cancer care. Qualitative clinical data-mining uncovered four music therapists' perspectives about music and music therapy's relevance for pediatric oncology patients up to 14 years old. Inductive and comparative thematic analysis was performed on focus group transcripts and qualitative interrater reliability integrated. Music can offer children a safe haven for internalizing a healthy self-image alongside patient identity. Music therapy can calm, relieve distress, promote supportive relationships, enable self-care, and inspire playful creativity, associated with "normalcy" and hope. Preferred music and music therapy should be available in pediatric oncology.

Music during after-death care: a focus group study

BACKGROUND

The intensive care unit (ICU) is not only a place to recover from injuries incurred during accidents and from serious illness. For many patients, it is also a place where they might die. Nursing care does not stop when a patient dies; rather, it continues with the care of the deceased and with family support. The aims of this study were (1) to explore the experiences and attitudes of nurses towards the use of ambient music in the ICU during after-death care and (2) to describe the feedback nurses received from relatives when music was used during the viewing.

METHOD

A qualitative design employing focus group interviews was used. Three focus group interviews with 15 nurses were conducted. All the interviews were audiotaped, transcribed verbatim and analysed using qualitative content analysis.

FINDINGS

Six main categories of attitudes emerged from the analysis: (1) different attitudes among nurses towards the use of music; (2) music affects the atmosphere; (3) music affects emotions; (4) use of music was situational; (5) special choice of music and (6) positive feedback from the bereaved.

CONCLUSION

This study demonstrates that music might be helpful for nurses during after-death care as well as for the care of the relatives.

RELEVANCE TO CLINICAL PRACTICE

Including ambient music in an after-death care programme can help nurses show respect for the deceased as the body is being prepared. Music played during the viewing may be a way of helping relatives in their time of grieving. It may ease the situation by making that event special and memorable. However, standardizing this intervention does not seem appropriate. Rather, the individual nurse and the family must decide whether music is to be used in a particular situation.

Music's relevance for pediatric cancer patients: a constructivist and mosaic research approach

PURPOSE

Music is important in most children's lives. To advance efficacious pediatric supportive care, it is necessary to understand young cancer patients' thoughts about music. Concern about inviting unwell children to express opinions has resulted in scant research examining their views. "Mosaic" research examines children's experiences through investigating multiple perspectives which inform a "co-constructed meaning." This study examines pediatric cancer patients' and their parents' perspectives about music and music therapy's role in the children's lives.

MATERIALS AND METHODS

Children were receiving care at three hospitals with the Paediatric Integrative Cancer Service in Melbourne, Victoria, Australia. A constructivist research approach with grounded theory design was applied. Children up to 14 years old with cancer and parents participated. Data included transcripts from semi-structured research interviews and observations of children's music behaviors. Qualitative inter-rater reliability was integrated. Findings were compared with music therapists' perspectives examined elsewhere.

RESULTS

Interviews were conducted with 26 patients, median age 5.7 years, and 28 parents. Data "saturation" was achieved. A substantive grounded theory emerged: Children's adverse cancer experiences are often alleviated by music usages. Broader family, social, and electronic musical interactions also promote children's resilience and "normal" development. Music therapy and associated programs often, but not always, alleviate children's distress. Positive effects may carry over into children's home lives and vicariously support families.

CONCLUSIONS

Health professionals should consider ways to assist parents who are often using music to support children with cancer. Hospitals can promote pediatric cancer patients' resilience by providing music-based support services, including music therapy, and reducing unwanted stressful sounds.

Introducing music therapy in hospice and palliative care: an overview of one hospice's experience

A middle-aged man with lung cancer breathes more easily and reduces his need for pain medication after participating in music-focused relaxation. An 8-year-old boy with cancer writes songs and records a CD for his family. An elderly woman in the final stages of Alzheimer's who is no longer able to speak sings a few words of her favorite lullaby to her adult daughter. A much-loved grandmother dies peacefully as her family sings her favorite spiritual songs to the accompaniment of a music therapist's folk harp. These illustrations demonstrate the role that music therapy plays in attending to the physical, emotional, and spiritual needs of hospice and palliative care patients and families while respecting their dignity and celebrating their lives.

The Meaning of the Music: The Role of Music in Palliative Care Music Therapy as Perceived by Bereaved Caregivers of Advanced Cancer Patients

In an earlier qualitative research study exploring the meaning of preloss music therapy to bereaved caregivers who participated in sessions through a home-based hospice program, various narrative accounts revealed the significance of music in music therapy sessions. In this study, the role of music in palliative care music therapy is examined and representatively summarized, followed by a review of strategies provided by this author to home hospice patients and their caregivers. The reported perceptions of the meaning of music to 7 bereaved caregivers are presented, including a review of themes and associated narrations that illustrated its significance. The caregivers described these aspects of music in sessions to have memorable and lasting effects as follows: ``music is a conduit,'' ``music gets inside us,'' ``live music makes a difference,'' and ``music is love.'' Findings support the benefits of preloss music therapy for bereaved caregivers.