One may ask, “Why is music so much a part of our everyday lives?” Music is with us whenever we want to listen, at the touch of a button on a phone or an iPod tucked in a pocket. Every moment of the day, most Americans can listen to an unlimited selection of music. Music has been a part of human history since the first records created. Today, people can download self-selected music to provide individualized music listening sessions that can be endlessly recreated. With such instant availability, how can nurse healers explore the conscious and intentional use of music as a modality for care and healing of their patients and themselves? What do nurse healers need to know to use music as a caring, healing modality?

As healers in the nurse-patient interaction, nurses employed in health systems are challenged to defend their use of music as a caring, healing modality. When nurses express the desire to include music (or another complementary care modality) as a standard of care for patients, they are told to provide outcome-based research demonstrating strong evidence (see Chapters 34 and 35) that music makes a difference in patient outcomes. Nurses are not only challenged in having to show “strong” evidence for their use of music listening when caring for individuals but are confronted with having limited time to carry out these caring, healing modalities in the busy healthcare industry.

In the effort to build a strong evidence base for music and its inclusion as a standard of care, the vast majority of new research addresses the functionality of music. Research questions most frequently asked include: What is music’s capacity to produce a clinical change in the patient’s condition? How does music produce this change?

In this chapter, the nurse healer is asked to carefully reread these questions in light of the research being published. The nurse healer is asked to reflect on the power of music as a therapeutic modality in holistic nursing care. Therefore, the nurse healer must consider: What research questions are not being asked? To begin exploring this journey in understanding music as a caring, healing modality, consider a quote from the book Musicophilia by Oliver Sacks:

Music has a long, rich history in the care of patients. The Greek philosopher Pythagoras, considered the founder of music therapy, promoted music for health in the sixth century.⁴ Pythagoras prescribed a specific diet and music to restore harmony of the body and soul. During the Crimean War, Florence Nightingale advocated the use of music in hospitals to aid in the healing of soldiers. As a critical observer of environmental effects on the human body, Nightingale noted that wind instruments producing a continuous sound had a beneficial effect and instruments that did not produce continuous sounds were detrimental. In Notes on Nursing, Nightingale wrote: “The effect of music upon the sick has been scarcely at all noticed. … wind instruments, including the human voice, and stringed instruments, capable of continuous sound, have generally a beneficent effect.”^5p33

The invention of the phonograph in the late 1800s made recorded music available for use in hospital settings. In 1926, another nurse led the world in utilizing music to create a healing environment. Isa Maud Ilsen founded the National Association for Music in Hospitals. Ilsen believed that music should be used for physical ailments
and pain. She proposed rhythm to be the basic therapeutic component in music.⁴

Music use in the care of hospitalized patients continued to gain popularity through the World Wars. However, with the advent of new medications for pain and anxiety, the popularity of music declined. With the recognition of the side effects associated with pharmaceutical management, there was a resurgence of interest in music in the 1990s. Research is supported by technical advancements in neuroimaging, and clinical application of music has increased as a result of technological advancements in music moving away from records, radio, and compact disc players to smart phones, iPods, and the iTouch.

Does the research currently reported support the historical role of music in care and healing? With the thrust for evidence-based practice, a multitude of studies on the effectiveness of music has been produced in the last decade. On a very happy note, research interest in music and health care has expanded into the natural setting. On a more dissonant note, the overall quality of the majority of clinical research studies has been poor as a result of heterogeneity of samples, small sample size, lack of randomization, and inconsistencies in the delivery of music interventions. Cochrane Reviews are one of the most highly regarded sources of evidence on a given topic, even if the results of the review indicate that not enough evidence is available for making a recommendation, results are conflicting, or results do not support a practice.⁶ Several recent Cochrane Reviews have been published and report very limited support for the use of music in clinical practice. Notably, these reviews consistently report that there was no difference in outcomes between interventions when music was selected by the researchers compared with self-selected music. Reviewers also consistently suggest the need for better study design and larger sample sizes in research evaluating the effects of music.

What is important for the nurse healer to know about Cochrane Reviews? First, Cochrane Reviews synthesize the results of clinical intervention research trials. Second, very stringent quality criteria must be met. At the present time, very few large clinical trials on the efficacy of music have been conducted. As a result, the Cochrane Reviews for music have been based on a very few (N = 4) to a moderate number of studies (N = 31). In addition, Cochrane Reviews as well as many other systematic review papers make a clear distinction between research in which the interventions are delivered by a certified music therapist (music therapy) and music interventions delivered by a health provider (also referred to as music medicine).⁷ According to the American Music Therapy Association, music therapy “is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”⁸ Certified music therapists individualize their interventions to meet patients’ specific needs through a clinical assessment, the delivery of a tailored music experience, and evaluation. Music therapy as delivered by a music therapist includes: (1) listening to live, improvised, or prerecorded music; (2) performing music on an instrument; (3) improvising music spontaneously using voice or instruments or both; (4) composing music; and (5) music combined with other modalities. Overall, music therapy interventions demonstrate more effectiveness than music delivered by a health provider. Strengths of music therapy interventions are the use of multiple modalities including active music participation, an individualized music therapy regime adapted over time, and direct interaction with a music therapist. When reading research on the effectiveness of music, it is important to note whether the intervention was delivered as a structure therapy approach by a music therapist or a music listening session delivered by a health provider. When considering using music as a caring, healing modality, nurses’ collaboration with a music therapist may enhance patients’ music experience, particularly for the use of music in the management of chronic illnesses.