Defining Attachment and Bonding: Overlaps, Differences and Implications for Music Therapy Clinical Practice and Research in the Neonatal Intensive Care Unit (NICU)

Preterm birth and the subsequent hospitalization in the Neonatal Intensive Care Unit (NICU) is a challenging life event for parents and babies. Stress, anxiety, and depressive symptoms, limitations in holding or touching the baby, and medical complications during the NICU stay can negatively affect parental mental health. This can threaten the developing parent-infant relationship and might adversely impact child development. Music therapy in the NICU is an internationally growing field of clinical practice and research and is increasingly applied to promote relationship building between parents and babies. The two most commonly used concepts describing the early parent-infant relationship are ‘attachment’ and ‘bonding’. While frequently used interchangeably in the literature, they are actually not the same and describe distinctive processes of the early relationship formation. Thus, it is important to discuss the overlaps and differences between attachment and bonding and the implications for music therapy clinical practice and research. Whereas providing examples and possible scenarios for music therapists working on either bonding or attachment, the distinction between both concepts is relevant for many health care professionals concerned with early parenting interventions in the NICU. This will hopefully lead to a more precise use of theory, and ultimately, to a more informed clinical practice and research.publishedVersio

Potential Psychological and Biological Mechanisms Underlying the Effectiveness of Neonatal Music Therapy during Kangaroo Mother Care for Preterm Infants and Their Parents

Neonatal music therapy (MT) has become more accessible worldwide. Previous research suggests multiple benefits of MT for preterm infants and their caregivers; however, far too little attention has been paid to understanding the mechanisms of change in previous Neonatal Intensive Care Unit (NICU)-MT research so far. This perspective article describes potential mechanisms of MT interventions exposed during kangaroo mother care on the preterm infant’s response (behavioral and physiological outcomes) and the mother-infant relationship. The paper focuses on the hypothalamic–pituitary–adrenal axis’ role in stabilization of behavioral state, the autonomic nervous system’s role in stabilization of physiologic state, as well as co-regulation as a potential mechanism for the developing of the parent-infant relationship. Mechanisms play a pivotal role in understanding variables related to the therapy course and well as in generating new knowledge regarding treatment susceptibility and optimizing resources. Understanding of the mechanisms of how interventions may lead to specific outcomes plays an important role in addressing the issue of improvement of currently available approaches of MT used in the NICUpublishedVersio

Family-centred music therapy with preterm infants and their parents in the Neonatal Intensive Care Unit (NICU) in Colombia – A mixed-methods study

This article reports a mixed-methods study of Music Therapy (MT) with preterm infants and their parents in a neonatal intensive care unit (NICU) in Colombia. The aim was to find out whether live MT during kangaroo care had an effect on the physiological outcomes of the neonates and would help parents to decrease their anxiety levels and improve parent–infant bonding. The participants were 36 medically stable neonates born between the 28th and 34th week of gestation and their parents. The quantitative data collection included heart rate, oxygen saturation, weight gain, length of hospitalization and re-hospitalization rate. The assessment measures for anxiety and bonding were the State-Trait Anxiety Inventory (STAI) and the Mother-to-Infant-Bonding Scale (MIBS). Thematic analysis was used to analyse the qualitative data collected with semi-structured interviews and questionnaires. The quantitative results showed statistically significant improvements in maternal state-anxiety (p = .007) and in the babies weight gain per day during the intervention period (p = .036). Positive trends were found regarding the babies’ length of hospitalization and re-hospitalization rate. Both parents improved their scores with the MIBS, but this was not statistically significant. The qualitative analysis showed that MT was important for parental well-being, for bonding and for fostering the development of the neonates. Interacting musically with their babies helped parents to experience feelings of connectedness and to distract themselves from their difficulties and from the noisy hospital environment

Ansiedad, dolor y resiliencia en pacientes con ventilación mecánica invasiva en la unidad de cuidado intensivo: estudio piloto

Introducción: cerca de 90% de los pacientes que ingresan a la unidad de cuidado intensivo (UCI) requieren intubación mecánica invasiva durante la estadía. Se han identificado síntomas como ansiedad y dolor,     que ponen a prueba la capacidad de adaptación del sujeto. Objetivo: describir la aplicabilidad de los instrumentos state-trait anxiety inventory (STAI), escala visual analógica (EVA) y brief resilience scale (BRS) en pacientes críticos con ventilación mecánica invasiva en la UCI de un hospital de alta complejidad de Bogotá. Metodología: estudio observacional, descriptivo de tipo transversal; la recolección de datos se realizó mediante las escalas de STAI-6, EVA y BRS para evaluar ansiedad, dolor y resiliencia en pacientes adultos con requerimiento de ventilación mecánica invasiva, el análisis de datos fue descriptivo en el software stata 17. Resultados: de los 23 participantes, 82.6% eran mujeres de 24 a 84 años, en cuanto a la aplicación de la escala de dolor, 78,26% de los pacientes lo calificaron como leve.  Al evaluar la ansiedad se encontró que 39.13% presentaban nivel alto y respecto a la escala de resiliencia 60.86% se encontraban en el rango normal. Conclusión: se identificó que el dolor fue el signo más fácil de valorar, la escala STAI-6 fue útil y de fácil aplicación para la detección de la ansiedad en pacientes críticos ventilados, la escala BRS fue poco específica y compleja para la comprensión y evaluación de la resiliencia de pacientes con ventilación mecánica

Perspectives on Musical Care Throughout the Life Course: Introducing the Musical Care International Network

Giorgos Tsiris - ORCID: 0000-0001-9421-412X https://orcid.org/0000-0001-9421-412XIn this paper we report on the inaugural meetings of the Musical Care International Network held online in 2022. The term “musical care” is defined by Spiro and Sanfilippo (2022) as “the role of music—music listening as well as music-making—in supporting any aspect of people's developmental or health needs” (pp. 2–3). Musical care takes varied forms in different cultural contexts and involves people from different disciplines and areas of expertise. Therefore, the Musical Care International Network takes an interdisciplinary and international approach and aims to better reflect the disciplinary, geographic, and cultural diversity relevant to musical care. Forty-two delegates participated in 5 inaugural meetings over 2 days, representing 24 countries and numerous disciplines and areas of practice. Based on the meetings, the aims of this paper are to (1) better understand the diverse practices, applications, contexts, and impacts of musical care around the globe and (2) introduce the Musical Care International Network. Transcriptions of the recordings, alongside notes taken by the hosts, were used to summarise the conversations. The discussions developed ideas in three areas: (a) musical care as context-dependent and social, (b) musical care's position within the broader research and practice context, and (c) debates about the impact of and evidence for musical care. We can conclude that musical care refers to context-dependent and social phenomena. The term musical care was seen as useful in talking across boundaries while not minimizing individual disciplinary and professional expertise. The use of the term was seen to help balance the importance and place of multiple disciplines, with a role to play in the development of a collective identity. This collective identity was seen as important in advocacy and in helping to shape policy. The paper closes with proposed future directions for the network and its emerging mission statement.https://doi.org/10.1177/205920432312005536aheadofprintaheadofprin

Musiktherapie während der end-of-life (Lebensende) Versorgung in der Neugeborenen-Intensivstation. Reflexionen aus früher klinischer Praxis in Kolumbien

当今，临终关怀音乐治疗在多种机构、多类人群中的临床应用都有了大幅度的增涨。然而，尽管音乐治疗在新生儿重症监护病房（NICU）中的临床研究和应用已经是一个较为完善的领域。在这个领域当中，有关在NICU里进行临终关怀服务的文献依然缺失。在本文中，笔者致力于反映出在陪伴着NICU中生命垂危的新生儿及他们的家人时，所面临的各种可能性、困难及挑战。本文将描述三个病例摘要，以此来举例说明仪式、文化、制造回忆及家庭中心护理等概念。笔者期望这些个案研究能够为关注NICU临终关怀服务的音乐治疗师及其他从业人员们提供一定启发，同时相互借鉴彼此的想法及经验。(笔译：李冰)Musiktherapie in der Versorgung am Lebensende ist eine zunehmend angewandte therapeutische Option für ein breites Spektrum von Populationen in unterschiedlichen Settings. Während die Musiktherapie in der Neugeborenen-Intensivstation (NICU) ein etabliertes Gebiet der klinischen Forschung und Praxis ist, gibt es einen Mangel an Literatur, die speziell Fragen behandelt, die die End-of-Life Versorgung in diesem Setting betreffen. In diesem Artikel will der Autor über die Potentiale, Schwierigkeiten und Herausforderungen reflektieren, wenn Babys und ihre Familien während ihrer letzten Lebensphase in der Intensivstation begleitet werden. Drei Fallvignetten werden beschrieben, um Aspekte der Ritualität, Kultur, das Schaffen von Erinnerungen und familienzentrierter Pflege zu exemplifizieren. Es ist zu hoffen, dass diese Fallstudien, den Austausch von Ideen und Erfahrungen zwischen Musiktherapeuten und anderen Gesundheitsexperten die sich mit End-of-Life-Versorgung in der Intensivstation beschäftigen, anstoßen. (Abstract übersetzt von Maren Metell)La musicoterapia durante l'assistenza al fine vita è diventata un'opzione terapeutica sempre più utilizzata per una vasta gamma di popolazioni, in una molteplicità di settings. Al tempo stesso, la musicoterapia nell'unità di terapia intensiva neonatale (NICU) è un settore ben consolidato di ricerca e pratica clinica, ma c'è una mancanza di letteratura che affronta in modo specifico i problemi relativi alla cura del fine vita in tale ambito. In questo articolo, l'autore vuole riflettere su alcuni potenziali, difficoltà e sfide che accompagnano i neonati e le loro famiglie durante le loro ultime fasi di vita in NICU. Tre illustrazioni di casi saranno descritte allo scopo di esemplificare aspetti legati a ritualità, cultura, memoria e cura di famiglia. Si spera che questi casi di studio incitino lo scambio di idee ed esperienze tra musicoterapisti e altri professionisti del settore sanitario, interessati alla cura di fine vita in NICU. (Abstract tradotto da Claudio Cominardi)終末ケアでの音楽療法は、ますます幅広い対象者領域で適用される療法の選択肢となってきた。新生児集中治療室（NICU）での音楽療法は臨床研究と実践において確立された一領域であるが、この設定における終末医療に関しては、具体的に言及した文献が欠如している。本稿は、NICUで終末期を迎える新生児とその家族に寄り添う際に起こりうるいくつかの可能性、困難、そして挑戦について省察することを目的とする。三つの症例場面を記述することにより、儀式的なもの、文化、思い出づくり、家族中心ケアといった側面を例示する。これらの症例研究が、NICUでの終末期医療に関心を持つ音楽療法士や他のヘルスケア専門職の間で、考えや経験の交換を促すきっかけとなることが望まれる。Music therapy during end-of-life care has become an increasingly applied therapeutic option for a broad range of populations in a variety of settings. While music therapy in the Neonatal Intensive Care Unit (NICU) is a well-established field of clinical research and practice, there is a lack of literature that specifically addresses issues related to end-of-life care in this setting. In this article, the author aims to reflect upon some of the potentials, difficulties, and challenges when accompanying babies and their families during their last stages of life in the NICU. Three case vignettes will be described in order to exemplify aspects related to rituality, culture, memory making, and family-centred care. It is hoped that these case studies prompt the exchange of ideas and experiences among music therapists and other health care professionals concerned with end-of-life care in the NICU

Music Therapy During End-of-life Care in the Neonatal Intensive Care Unit (NICU) – Reflections from Early Clinical Practice in Colombia

La musicoterapia durante l'assistenza al fine vita è diventata un'opzione terapeutica sempre più utilizzata per una vasta gamma di popolazioni, in una molteplicità di settings. Al tempo stesso, la musicoterapia nell'unità di terapia intensiva neonatale (NICU) è un settore ben consolidato di ricerca e pratica clinica, ma c'è una mancanza di letteratura che affronta in modo specifico i problemi relativi alla cura del fine vita in tale ambito. In questo articolo, l'autore vuole riflettere su alcuni potenziali, difficoltà e sfide che accompagnano i neonati e le loro famiglie durante le loro ultime fasi di vita in NICU. Tre illustrazioni di casi saranno descritte allo scopo di esemplificare aspetti legati a ritualità, cultura, memoria e cura di famiglia. Si spera che questi casi di studio incitino lo scambio di idee ed esperienze tra musicoterapisti e altri professionisti del settore sanitario, interessati alla cura di fine vita in NICU. (Abstract tradotto da Claudio Cominardi)当今，临终关怀音乐治疗在多种机构、多类人群中的临床应用都有了大幅度的增涨。然而，尽管音乐治疗在新生儿重症监护病房（NICU）中的临床研究和应用已经是一个较为完善的领域。在这个领域当中，有关在NICU里进行临终关怀服务的文献依然缺失。在本文中，笔者致力于反映出在陪伴着NICU中生命垂危的新生儿及他们的家人时，所面临的各种可能性、困难及挑战。本文将描述三个病例摘要，以此来举例说明仪式、文化、制造回忆及家庭中心护理等概念。笔者期望这些个案研究能够为关注NICU临终关怀服务的音乐治疗师及其他从业人员们提供一定启发，同时相互借鉴彼此的想法及经验。(笔译：李冰)終末ケアでの音楽療法は、ますます幅広い対象者領域で適用される療法の選択肢となってきた。新生児集中治療室（NICU）での音楽療法は臨床研究と実践において確立された一領域であるが、この設定における終末医療に関しては、具体的に言及した文献が欠如している。本稿は、NICUで終末期を迎える新生児とその家族に寄り添う際に起こりうるいくつかの可能性、困難、そして挑戦について省察することを目的とする。三つの症例場面を記述することにより、儀式的なもの、文化、思い出づくり、家族中心ケアといった側面を例示する。これらの症例研究が、NICUでの終末期医療に関心を持つ音楽療法士や他のヘルスケア専門職の間で、考えや経験の交換を促すきっかけとなることが望まれる。Musiktherapie in der Versorgung am Lebensende ist eine zunehmend angewandte therapeutische Option für ein breites Spektrum von Populationen in unterschiedlichen Settings. Während die Musiktherapie in der Neugeborenen-Intensivstation (NICU) ein etabliertes Gebiet der klinischen Forschung und Praxis ist, gibt es einen Mangel an Literatur, die speziell Fragen behandelt, die die End-of-Life Versorgung in diesem Setting betreffen. In diesem Artikel will der Autor über die Potentiale, Schwierigkeiten und Herausforderungen reflektieren, wenn Babys und ihre Familien während ihrer letzten Lebensphase in der Intensivstation begleitet werden. Drei Fallvignetten werden beschrieben, um Aspekte der Ritualität, Kultur, das Schaffen von Erinnerungen und familienzentrierter Pflege zu exemplifizieren. Es ist zu hoffen, dass diese Fallstudien, den Austausch von Ideen und Erfahrungen zwischen Musiktherapeuten und anderen Gesundheitsexperten die sich mit End-of-Life-Versorgung in der Intensivstation beschäftigen, anstoßen. (Abstract übersetzt von Maren Metell)Music therapy during end-of-life care has become an increasingly applied therapeutic option for a broad range of populations in a variety of settings. While music therapy in the Neonatal Intensive Care Unit (NICU) is a well-established field of clinical research and practice, there is a lack of literature that specifically addresses issues related to end-of-life care in this setting. In this article, the author aims to reflect upon some of the potentials, difficulties, and challenges when accompanying babies and their families during their last stages of life in the NICU. Three case vignettes will be described in order to exemplify aspects related to rituality, culture, memory making, and family-centred care. It is hoped that these case studies prompt the exchange of ideas and experiences among music therapists and other health care professionals concerned with end-of-life care in the NICU

Music Therapy Self-Care Group for Parents of Preterm Infants in the Neonatal Intensive Care Unit: A Clinical Pilot Intervention

Background: The parents of preterm infants face major mental health challenges in the Neonatal Intensive Care Unit (NICU). Family-centered music therapy actively integrates and empowers parents in their infants’ care. With the aim to better understand and address parental needs separately from their babies’ needs, a music therapy (MT) self-care group was implemented as part of clinical practice at the hospital Clínica de la Mujer, in Bogotá, Colombia. Methods: The group was provided for both parents, twice a week, in the NICU. Music guided relaxations, breathing techniques, and self-expression were at the center of the MT group sessions. The parents completed a pre/post self-administered Numeric Rating Scale (NRS), including anxiety levels, stress levels, mood and motivation. Results: The parents highly valued the MT self-care group in the NICU. On average, there was a 37% improvement in anxiety levels, 28% improvement in stress levels, and 12% improvement in mood, restfulness and motivation. Being able to relax, to distract themselves from their worries and having time for themselves are amongst the most frequently mentioned benefits. Conclusions: Addressing parents’ needs separately from their babies’ treatment, with culturally sensitive interventions aimed at improving parental mental health, is essential for continuing the development of family-centered music therapy interventions in the NICU

Data_Sheet_1_Intersections of the arts and art therapies in the humanization of care in hospitals: Experiences from the music therapy service of the University Hospital Fundación Santa Fe de Bogotá, Colombia.PDF

Humanization of care is becoming an increasingly important aspect in providing high-quality health services and the arts are more and more implemented to support and foster humanization and person-centered care efforts. Musical experiences are one of the most frequently encountered art forms in medical settings. Music therapy as a healthcare profession has a decades-long tradition in hospitals, both in inpatient and outpatient areas. However, while studies regarding the effectiveness of music therapy are on the forefront of clinical research, little attention has been paid to the profession's inherent opportunities to assist the hospitals' strategies in terms of humanization of care. Yet, the musical experiences in music therapy are especially versatile in supporting healthcare users from a holistic perspective, contributing to a more compassionate, personalized, and humanized environment. In this article, the basic pillars of humanized and person-centered care will be outlined, followed by examples of seven intersections in which the music therapy service of the University Hospital Fundación Santa Fe de Bogotá aligns with its Humanized and Compassionate Care Model. The aim of this article is to stimulate the discussion on music therapy not only as a profession that provides safe and effective treatment, but also as a therapeutic art experience that can add value for hospitals on their path toward a more humanized care culture.</p