Journal of Pediatric Nursing 73 (2023) e138–e145

Contents lists available at ScienceDirect

Journal of Pediatric Nursing

journal homepage: www.pediatricnursing.org

Pediatric staff and their perceptions of music therapy services

Austin C. Thorn, MT-BC , Kristin Brown, CCLS *, Marlena Tolland, CCLS , Jenna Read, MS, CCLS
Nemours Children's Hospital, Orlando, FL, United States

A R T I C L E I N F O A B S T R A C T

Keywords: Purpose: To reveal the benefits, needs, and limitations of music therapy observed by clinical pediatric staff at a
Music therapy children's hospital in the United States of America.
Pediatric Design and methods: Researchers developed an electronic 13-question survey and distributed the survey in the fall
Rehabilitation
of 2022. Questions included demographics, Likert-type scale, and open-ended queries. Data was collected via
Intensive care unit
Pediatric cancer
Qualtrics and analyzed using descriptive statistics and content analysis.
Results: A total of 83 pediatric staff completed the survey. Staff observed positive benefits, where the highest
reported areas were opportunities for dealing with anxiety/stress (94.7%), opportunities for social interaction
(93.3%), and quality of life (89.3%). Analysis of free-response questions suggest that staff expect expertise and a
nuanced understanding of the needs of each of their clinical units.
Conclusion: Results suggest that staff possess an overall positive attitude toward music therapy in all settings
served. Music therapists may be valuable for psychosocial and rehabilitative support to hospitalized children and
their families.
Practice implications: Nursing staff may utilize music therapists to improve patient outcomes and reduce the
negative effects of hospitalization.

Background pediatric medical setting, yet how staff view the various benefits pro­
vided by music therapists remains largely unexplored (Stegemann et al.,
Music therapy in pediatrics 2019). Two studies have surveyed staff in pediatric out-patient reha­
bilitation and oncology settings regarding their perceptions of music
Music therapists have become a popular addition to pediatric facil­ therapy (Darsie, 2009; Monas, 2013). These studies found positive at­
ities in recent years. Music therapy is the clinical & evidence-based use titudes toward the use and inclusion of music therapy by different dis­
of music interventions to accomplish individualized goals within a ciplines, including physicians, nurses, and rehabilitation therapists,
therapeutic relationship by a credentialed professional who has among others. And like pediatric nursing, family-centered care has
completed an approved music therapy program (American Music emerged as a standard practice for pediatric music therapists (Avers
Therapy Association, 2023). Music therapists receive the MT-BC et al., 2007; Harrison, 2010). More broadly, Stegemann et al. (2019)
credential from the Certification Board for Music Therapists after provided an overview of music therapy and music-based interventions in
completing a music therapy degree, internship, and passing a board the pediatric setting. This study included 13 systematic reviews/meta-
exam (American Music Therapy Association, 2023). Notably, music analyses and concluded that music therapy can be a safe intervention
therapy programs are found in all U.S. News World Report's Best Chil­ that alleviates symptoms and improves quality of life. For example,
dren's Hospitals (American Music Therapy Association, 2021). Organi­ music therapists can provide an effective individualized service
zationally, music therapy is typically embedded within a Child Life providing procedural support for invasive procedures to mitigate pain
Department (Knott et al., 2020). Music therapy at the researcher's or­ and stress, redirect patient focus, and facilitate health coping (Ghetti,
ganization works within the child life and creative arts therapies team 2012). Music therapy at the researcher's hospital covers in-patient units,
under the department of Patient and Family Services, which additionally including hematology/oncology, neonatal intensive care, rehabilitation,
includes social work, spiritual care, and interpretive services. cardiac intensive care, pediatric intensive care, and medical/surgical.
There is substantial literature to support music therapy in the Other hospitals have music therapy services present in other settings,

* Corresponding author at: Nemours Children's Hospital, 6535 Nemours Parkway, FL 32827, United States.
E-mail address: [email protected] (K. Brown).

https://doi.org/10.1016/j.pedn.2023.08.001
Received 25 May 2023; Received in revised form 2 August 2023; Accepted 3 August 2023
Available online 9 August 2023
0882-5963/© 2023 Elsevier Inc. All rights reserved.
A.C. Thorn et al. Journal of Pediatric Nursing 73 (2023) e138–e145

such as out-patient dialysis or out-patient rehabilitation, radiology, and NICU staff agree that music can reduce stress and improve sleep (Bou­
emergency settings (Knott et al., 2020). In order to provide context for hairie et al., 2006; Kemper et al., 2004). However, these studies only
staff's perceptions, we first present outcomes of music therapy research considered recorded music and live harp playing and not interventions
in areas serviced at the researcher's hospital. by certified music therapists.

Music therapy in cancer treatment Music therapy in rehabilitation

Cancer remains one of the leading causes of death by disease in Physical therapy is a treatment that can often be painful and stress-
children in the United States of America, where diagnosis and treatment inducing. Distraction is known to be a beneficial tool to overcome
of every child requires the collaboration of a large interdisciplinary team pain and stress in children (Koller & Goldman, 2012). Often times, music
(National Cancer Institute, 2021). In 2015, a group of pediatric oncology therapy utilizes live music implemented by the music therapist, and the
psychosocial professionals established fifteen psychosocial standards of patient is encouraged to take an active role in the intervention, including
care (PSC) to guide care for patients and their families throughout their but not limited to singing, playing instruments, or moving to music to
treatment (Wiener et al., 2015). According to the National Cancer help meet their non-musical goals, such as engagement in therapies
Institute (2023), psychosocial support refers to “support given to help (Gooding & Yinger, 2015). ‘Kobus et al. (2022a) performed a study in
meet the mental, emotional, social, and spiritual needs of patients and which results showed that using music therapy as a part of an interdis­
their families.” Knott et al. (2022) outlined how nine of these standards ciplinary practice involving physical therapy improves functional out­
are currently implemented by music therapists, according to their comes. Moreover, Bringas et al. (2015) suggested that instead of simply
standards of practice. They include providing psychosocial assessment increasing the amount of a specific rehabilitation intervention, programs
(PSC:1), psychosocial interventions and therapeutic support (PSC:4), should enhance standard treatments by using different adjunct proced­
assessment and support of caregiver needs (PSC:6), psychoeducation for ures such as music therapy in producing further improvements in the
patients and families (PSC:7), procedural preparation and support cognitive performance of children with diverse and severe neurological
(PSC:8), providing children and adolescents with social interaction disorders. This study also suggests that music therapy interventions
(PSC:9), sibling support (PSC:10), palliative care (PSC:13), and enhanced children's motivation and social behavior, thereby accounting
communication, documentation, and training (PSC:15). A Cochrane for the specific improvements in communication, cooperativeness, and
review found evidence for music therapy and music medicine in­ awareness of other children (Bringas et al., 2015).
terventions to be beneficial for improving quality of life and for common Neurologic Music Therapy is “the therapeutic application of music to
symptoms of cancer treatment, such as anxiety, pain, and fatigue (Bradt cognitive, affective, sensory, language, and motor dysfunctions due to
et al., 2016). Pediatric oncology staff have shown favorability for music disease or injury to the human nervous system (Thaut & Hoemberg,
to reduce stress and improve sleep, although music medicine, not music 2014, p. 2). This modality guides music therapists to improve functional
therapy, was studied (Bouhairie et al., 2006). outcomes in a variety of targeted interventions, such as Rhythmic
Auditory Stimulation ® for gait rehabilitation, Therapeutic Instrumental
Music therapy in neonatal intensive care Music Performance ® for motor control, and Melodic Intonation Ther­
apy for speech recovery, among others (Thaut & Hoemberg, 2014).
Music therapists provide a variety of individualized, family-centered Previous studies have showed the efficacy of music therapy to enhance
interventions to meet the neurodevelopmental needs of premature in­ patient engagement and provide opportunity for purposeful, structured
fants and the psychosocial needs of their families. A survey of music rehabilitation interventions (Weller & Baker, 2008). Both music thera­
therapists providing services to neonatal intensive care units (NICU) in pists at this hospital are NMT-certified.
the United States of America suggests that most hold the NICU-MT
certificate as certified by the National Institute for Infant and Child Music therapy in cardiac intensive care
Medical Music Therapy (Knott et al., 2020). This credential trains
therapists in administering evidence-based interventions, such as There is increasing demand for creative art and alternative therapies
Multimodal Neurologic Enhancement (MNE) and Pacifier-Activated in critical care. One study in the cardiac intensive care unit (CICU)
Lullaby (PAL®). The MNE technique has been shown to improve in­ examining infants' response to music therapy found that infants expe­
fant short-term neurodevelopment and improve long-term develop­ rienced a decrease in heart and respiratory rates (Yurkovich et al.,
mental outcomes, while PAL® has been shown to facilitate feeding 2018). Children with congenital heart defects have also been observed
skills, improve pain relief, reduce crying, and reduce length of stay post-operatively while receiving music therapy interventions and have
(Cevasco-Trotter et al., 2019; Detmer et al., 2020; Robertson & Detmer, been found to have reduced pain (Hatem et al., 2006). One study by
2019; Standley, 2012a; Standley, 2012b; Walworth et al., 2012; Whip­ Abd-Elshafy et al. (2015) found that post-operative music therapy in­
ple, 2008). The music therapists present at the authors' hospital are both terventions can lead to lower levels of post-traumatic stress disorder and
NICU-MT certified and employ these interventions regularly. occurrence of negative postoperative behavior in children with
Both live music (implemented by a certified music therapist) and congenital heart defects. When studying the perception of music therapy
recorded music have been shown to stabilize or improve infants' phys­ interventions in the CICU, two parties' perceptions to greatly consider
iological status, as well as support parent-infant bonding and reduce are parents of patients as well as nurses who provide bedside care.
parent's level of stress, anxiety, and depression (Bollard-Marcovitz et al., Sorensen et al. (2022) asked parents if they were satisfied with the music
2022; Corrigan et al., 2022; Kobus et al., 2022c; Palazzi et al., 2018). therapy provided to their newborns in the CICU, and parents either
Research supports music therapy protocols that address pacification, “agreed” or “strongly agreed” to the efficacy of music therapy in­
reinforcement of sucking, and multimodal stimulation, while a system­ terventions. One study by Tracy et al. (2003) studied nursing attitudes
atic review outlined music-based interventions for improvements in toward the use of alternative therapies, such as music therapy, and
preterm infant pain relief, weight gain, eating behavior, sleep quality, found that 88% of nurses were open or eager to using these therapies.
and cardiac and respiratory function (Costa et al., 2022; Standley,
2012a). Although evidence is mainly positive, reviews and meta- Music therapy in pediatric intensive care
analysis of the literature also suggest that this area of research lacks
large sample sizes, consistent intervention design, quality of evidence, Music therapy can be especially beneficial in the pediatric intensive
and assessment of long-term outcomes (Bieleninik et al., 2016; Pineda care unit (PICU), improving a child's outcomes and providing PICU staff
et al., 2017; Van Der Heijden et al., 2016). Studies have suggested that with a helpful nonpharmacologic intervention (Liu et al., 2020). In a

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study conducted by Kobus et al. (2022b), music therapy showed age, and must have worked day shifts during the week when music
decreased heart rates and blood pressure, along with an increase in therapy is present. Units serviced by the music therapists included he­
oxygen saturation. Research and clinical experience suggest that live matology/oncology, rehabilitation, cardiac intensive care, pediatric
music may be more advantageous than recorded music in reducing the intensive care, neonatal intensive care, medical/surgical acute care, and
pain and anxiety of critical care patients, due to the adaptability of music resource/float. Researchers collected staffing numbers from the nurse
delivery by a trained music therapist (Bush et al., 2021). Notably, music managers of each eligible unit to ascertain possible response rate. As of
therapy is also beneficial for providing appropriate sensory stimulation, August 2022, 193 staff were identified as eligible for participation.
humanizing the hospital experience, and providing a resource to overly
stressed family members (Ghetti, 2013).
Survey instrument
Music therapy at end of life
The researchers designed a 13-question survey via Qualtrics, a secure
Several music therapy interventions exist that are transferable, and electronic software, which collected the results. The survey was devel­
perhaps more meaningful, during bereavement and hospice situations. oped by the study team based on clinical practice and prior survey
Music therapy has been seen as a means of enhancing expression, studies and were reviewed by two experienced music therapists at other
communication, and remembrance after working with terminally ill pediatric facilities to ensure generalizability and ease of use (Knott et al.,
children (Love et al., 2022; Lindenfelser, Grocke and McFerran, 2008). A 2020; Tabinowski, 2013). Questions included nominal, ordinal, discrete,
common intervention for music therapists to provide is to create rank order, and open-ended response options. Participants were first
amplified cardiopulmonary recordings, or heartbeat recordings, for asked demographic questions such as gender, occupation type, years
families which allows families to listen to their child's heartbeat either employed, and units served. Participants were allowed to select multiple
alone or mixed with chosen music. Parental perceptions of end-of-life units as many roles provide cross-coverage. Next, participants indicated
music therapy interventions is crucial in determining their efficacy level of agreement with twelve observations of music therapy services
and legitimacy. One study of heartbeat recordings showed that half of on a 5-point scale (strongly disagree to strongly agree). Then partici­
parents reported listening to the recording frequently, and a third of pants indicated the impact of music therapy on twelve clinical outcomes
parents reported listening to the recording at least once after receiving on a 6-point scale (significantly negative to significantly positive,
it, indicating this intervention is a tangible and well-received interven­ including ‘not seen’). Participants then ranked preference of methods for
tion for bereaved families (Schreck et al., 2022). One study describes the providing education to staff. Finally, open-ended questions allowed
benefits of legacy interventions to promote emotional expression and participants to describe training they expect music therapists to have,
processing grief and highlights the need for an individualized approach what barriers to utilizing music therapists might exist, and if there is
(Love et al., 2022). Another intervention is to engage children in song­ anything the participant might want the researchers to know. Partici­
writing. This intervention aims to enhance self-esteem, coping, pants were allowed to skip questions or leave the survey at any point.
emotional expression, and meaning making (Myers-Coffman, Baker and The researchers first tested the survey to ensure proper mechanics and
Bradt, 2019). Overall, these interventions are individualized and pre­ ease of use on both computer and phone.
sented to families as opportunities to create a legacy for this child. To
our knowledge, how staff implement and perceive the benefits of legacy Procedures
interventions have not been researched.
The primary purpose of the present study is to elucidate how staff in To assess the potential number of participants, nurse managers
a pediatric hospital perceive the function and benefits of music therapy. provided the researchers lists of their eligible staff. These lists allowed
Additionally, we sought to explore potential barriers for staff to utilize the child life and creative arts manager to email potential participants
music therapy services. Music therapy serves as one of many possible with a survey notice. On the day staff were emailed, flyers with a secure
roles that contribute to the care of young patients and their families. QR code (generated by Qualtrics) were placed in employee break rooms.
Medical staff, especially nursing, are ever-present in the care of patients. Then, over the period of the next week, paper notices with QR codes
The relationships they build with families provide valuable insights and were given to eligible nursing staff on the units by the researchers.
thereby elevate the quality of care one receives. Now, psychosocial Participants read an information sheet and were provided informed
services, such as child life and social work, have become a standard of consent electronically prior to entering the survey. Results were
care especially in pediatric facilities (Scialla et al., 2017). These services collected by the child life and creative arts manager, de-identified, and
specialize all manner of mental, physical, financial, and spiritual support provided to the researchers for analysis. Data were organized by ques­
and therefore, quality interdisciplinary collaboration is imperative for tion, clinical role, and by unit to explore potential relationships. Re­
providing comprehensive, holistic care. This survey was an effort to searchers employed descriptive statistics to generate percentages of
develop staff's awareness of music therapy services, promote cohesive participant responses. Open-ended questions were each analyzed sepa­
care between clinical roles, and provide insight into how music thera­ rately via content analysis, specifically the “Cutting and Sorting” tech­
pists might approach education and advocacy. nique as described by Ryan and Bernard (2003). Researchers
independently identified repetitious and like words and phrases and
Method arranged them into groups. These groups were compared and revised,
and the researchers agreed on key themes that best represented the re­
Participants and setting sponses of each question.

An electronic survey was available in the fall of 2022 and completed

by clinical staff at a stand-alone 137-bed pediatric hospital in the Ethical considerations
Southeastern region of the United States. Eligibility for participation
included specific clinical roles who primarily served in-patient units This study was approved by Nemours Children's Health Institutional
alongside music therapists. Eligible roles included: registered nurse, Review Board (#1926153). Survey results were de-identified by the
patient care technician, rehabilitation therapist (physical therapist, child life and creative arts manager, a non-clinical role, so that the re­
occupational therapist, speech language pathologist), psychologist, searchers would not be able to identify participants. Results were
child life specialist, social worker, and spiritual care. Additionally, secured on password-protected computers only accessible to the
participants were required to comprehend English, be at least 18 years of researchers.

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Results have specialized training/education to work on their unit were provided

a free response option to elaborate on preferred training requirements.
Demographics Cutting and Sorting (Ryan & Bernard, 2003) of the 48 responses
revealed three themes: (a) education and training, (b) knowledge of
The response rate was calculated as 43%, with 83 staff participating appropriate psychosocial interventions, and (c) awareness of the inter­
out of an eligible 193. Clinical roles included registered nurses (n = 47), section of music and medicine. Responses related to education and
patient care technicians (n = 12), rehabilitation therapists (n = 10), training included that music therapists should have at least a bachelor's
social workers (n = 6), child life specialists (n = 2), psychologists (n = 2), degree, a certification, the ability to play various instruments, and
one spiritual care provider, and three un-identified professions. Units medical knowledge related to diagnoses and symptoms (e.g., effects of
served were represented by the following (and include participants who leukemia, traumatic brain injury), as well as medical devices (e.g.,
cover multiple units): PICU (n = 28), Acute (n = 25), NICU (n = 21), administering chemotherapy, respiratory machines), and mobility re­
Rehabilitation (n = 17), CICU (n = 16), Hematology/Oncology (n = 16), strictions (e.g., IV lines). Knowledge of appropriate psychosocial in­
Resource/Float (n = 2). Participants were mostly female (n = 81) with terventions includes the ability to provide end-of-life care (e.g.,
two males. Years employed at this hospital were represented by the memory-making, legacy building), to work with family units, and the
following: more than 5 years (n = 27), less than 1 (n = 20), 1–2 years (n ability to tailor interventions to a patient's preferences, condition, and
= 18), and 2–5 years (n = 18). culture. The intersection of music and medicine suggested that music
therapists should understand the effects of music in relation to patient
Staff perceptions of music therapy services acuity (e.g., sedation, pain, and appropriate stimulation), neurodiversity
(e.g. autism spectrum disorder), and development (e.g., sound process­
Staff were first asked to rate their level agreement with statements ing of neonates).
about different aspects of music therapy services. Table 1 shows the The survey incorporated two free response questions. The first asked
responses to each statement. Staff had the greatest agreement (somewhat staff what might prevent or discourage them from utilizing music ther­
agree and strongly agree) that (1) staff support research being done on apy services for their patients. Cutting and Sorting technique (Ryan &
their unit (98.6%), (2) music therapy is beneficial for patients, regard­ Bernard, 2003) of 40 responses provided three themes of what might
less of identity, condition, or background (97.4%), and (3) most patients prevent music therapy from being utilized, including (a) awareness and
could benefit from music therapy (97.4%) Statements with the greatest understanding of music therapy, (b) patient acuity, and (c) receptivity of
disagreement (strongly disagree and somewhat disagree) were (1) each of patients or their families. Awareness and understanding of music ther­
my patients/families are aware that music therapy is offered (30.2%), apy included staff who were unsure of how or when to consult, the
(2) staff know how to provide music therapy with referrals (16.9%), and availability of the therapists, and not knowing possible benefits of music
that (3) music therapists visit their patients often enough (15.6%). therapy to their patients. Patient acuity is defined as: the condition of the
Next, Table 2 shows results of how staff view the impact of music patient, which includes their diagnosis, symptoms, mood, affect, and
therapy on clinical outcomes. The areas which saw the most positive other environmental factors that affect their quality of life or ability to
effects were (1) opportunities for dealing with anxiety/stress (94.7%), participate with others. Staff indicated patient acuity factors that would
(2) opportunities for social interaction (93.3%), and (3) quality of life prevent them from utilizing music therapy, such as patients who are too
(89.3%). No negative outcomes were reported by staff. After, staff were overwhelmed or aggravated by hospitalization or patients with sensory
asked in which three areas does a music therapist support their patients limitations (e.g., critical patients requiring no/low stimulation), contact
the most. Opportunities for dealing with anxiety/stress were identified isolation, or medical restrictions (e.g., on a ventilator). Receptivity of
the most (n = 53), followed by relaxation, rest, or sleep (n = 29) and patients and families included responses whereby staff indicated they
opportunities for social interaction (n = 29). Staff then ranked which would defer to families in choosing whether to receive music therapy (e.
form of education they would prefer to learn about the use and benefits g., “If patient or family declines”).
of music therapy. Most clinicians ranked ‘virtual or in-person presen­ Last, staff were asked if there were any other considerations. Two
tation’ (n = 21) the highest, followed by ‘observation of a music therapy themes from this question included the positive impact of music therapy
session’ (n = 19), video summary (n = 10), knowledge of research and recommendations for increasing services. Several participants
outcomes (n = 7), and ‘informational flyer’ (n = 4). Thirty-four clini­ highlighted personal observations about the benefit of music therapy or
cians ranked ‘informational flyer’ as the least preferred method. a favorable view of music therapy. As one nurse stated “Music therapy is
vital and an important aspect in critical care. As patients get better, we should
Free responses encourage outlets to express how the visit has affected them even if via song.
Seeing firsthand, music therapy has helped patients expressed their social,
Staff who marked in agreement to whether music therapists should mental, and emotional strain from being admitted to the PICU.” Participants

Table 1
Staff agreement with music therapy utility.
Statement Strongly Somewhat Neutral Somewhat Strongly
Disagree Disagree Agree Agree

Each of my patients/families are aware that music therapy is offered. (n = 83) 9.6% 20.6% 32.5% 26.5% 10.8%
Music therapy treatment is individualized to each patient/family. (n = 83) 0% 0% 8.4% 16.9% 74.7%
Music therapists should have specialized training/education to work in my unit. (n = 83) 1.2% 7.2% 21.7% 32.5% 37.4%
A music therapist visits my patients often enough. (n = 83) 3.6% 12.0% 18.1% 38.6% 27.7%
I know how to provide music therapy with referrals. (n = 83) 1.2% 15.7% 12% 20.5% 50.6%
I have a clear understanding of how music therapy can support my patients. (n = 83) 0% 0% 4.8% 32.5% 62.7%
I support research on music therapy being done on my unit. (n = 73) 0% 1.4% 0% 4.1% 94.5%
Music therapy is beneficial for patients, regardless of identity, condition, or background. 1.3% 0% 1.3% 14.5% 82.9%
(n = 76)
Music therapy is an important part of patient's treatment. (n = 76) 0% 1.3% 4.0% 26.3% 68.4%
Music therapy enhances overall care for my patients (n = 79) 1.3% 0% 1.3% 10.1% 87.3%
I think most of my patients could benefit from music therapy. (n = 76) 1.3% 0% 1.3% 14.5% 82.9%
My patients and families have benefitted from receiving music therapy. (n = 76) 1.3% 0% 5.3% 10.5% 82.9%

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Table 2
Staff perception of music therapy outcomes.
Outcome Significantly Negative Somewhat Negative Neutral Somewhat Positive Significantly Positive Not Seen

Collaborating with Staff (n = 74) 0% 0% 10.8% 12.2% 71.6% 5.4%

Length of stay (n = 75) 0% 0% 22.6% 14.7% 48% 14.7%
Non-pharmacological pain management (n = 75) 0% 0% 12% 28% 52% 8%
Opportunities for dealing with anxiety/stress (n = 75) 0% 0% 0% 13.3% 81.4% 5.3%
Opportunities for expressing needs/concerns (n = 75) 0% 0% 9.3% 25.4% 48% 17.3%
Opportunities for social interaction (n = 75) 0% 0% 1.3% 13.3% 80% 5.4%
Palliative/End of life care (n = 75) 0% 0% 22.7% 10.7% 41.3% 25.3%
Parent adjustment to hospitalization (n = 75) 0% 0% 17.3% 16% 50.7% 16%
Procedural Support (n = 75) 0% 0% 18.7% 17.3% 50.7% 13.3%
Quality of life (n = 75) 0% 0% 8% 20% 69.3% 2.7%
Sensory needs/difficulties (n = 75) 0% 0% 6.6% 14.7% 62.7% 16%
Sibling Support (n = 74) 0% 0% 17.6% 8.1% 43.2% 31.1%

also made statements recommending more coverage by music therapists confirmed that music therapy can be beneficial for patients in intensive
on their units (e.g., requesting coverage for outpatient rehabilitation care units to receive positive stimulation and support for their siblings
services). and parents (Ghetti, 2013). Further, staff supported music therapy for
anxiety/stress reduction, non-pharmacological pain management, and
Discussion procedural support, factors which can reduce trauma and improve pa­
tient compliance (Bush et al., 2021; Gooding & Yinger, 2015; Liu et al.,
Across all service areas 2020). Therefore, music therapy can be seen as a multi-dimensional
service which alleviates psychological and social stressors existent in
Efforts to normalize the pediatric environment through imple­ intensive care settings.
mentation of psychosocial support has become a standard practice
(Wiener et al., 2015). Music therapists provide psychosocial support by Cancer
using elements of music and a therapeutic relationship to alleviate
symptoms, address developmental needs, and support families (Amer­ Cancer treatment severely disrupts the livelihoods of children, who
ican Music Therapy Association, 2021). In order for music therapy to be face painful procedures, uncomfortable symptoms, and social and aca­
utilized, staff must trust that therapists are part of the healthcare team demic disruptions (Wiener et al., 2015). All hematology/oncology par­
with the goal to enhance the plan of care. Responses to this survey ticipants recognized a positive impact of music therapy on quality of life
indicate a consensus that music therapy can be beneficial in intensive and social interaction. A majority of staff also recognized a positive
care as well as in cancer treatment and rehabilitation settings. These impact on procedural support, parent adjustment, palliative care, and
results not only indicate a trust by staff for music therapists to provide collaborating with staff. Results of outcomes seen by staff appear to be
services, but a need for increased awareness and services. As in past consistent with several psychosocial standards of care outlined by
studies, nurses continue to hold positive attitudes toward music therapy Wiener et al. (2015) including providing psychosocial interventions and
(Bouhairie et al., 2006; Kemper et al., 2004; Tracy et al., 2003). Over therapeutic support (PCS:4), assessment and support of caregiver needs
90% of nurses indicated that music therapy enhanced overall care, is (PCS:6), procedural support/preparation (PCS:8), providing social
important to treatment, and is beneficial regardless of identity, condi­ interaction (PCS:9), and palliative care (PSC:13). Some standards were
tion, or background. This is important to demonstrate how patient care not directly asked about, such as psychosocial assessment and psycho­
has grown in scope to account for social and emotional needs. Nurses education for patients. These results are also consistent the psychosocial
viewed music therapy as particularly beneficial for reducing anxiety/ standards implemented by music therapists identified by Knott et al.
stress, providing social interaction, improving quality of life, and sup­ (2022).
porting rest. Children and adolescents are particularly vulnerable for
psychological stress due to hospitalization and staff appear to view Rehabilitation
music therapy as important in addressing holistic needs of families.
In our study, 80% of respondents agreed that music therapy had a Most all rehabilitation staff indicated agreement with statements
somewhat positive role in providing non-pharmacological pain man­ about the positive outcomes of music therapy interventions. Of 14 staff
agement which correlates to the research done by Hatem et al. (2006). in rehabilitation, 13 marked that music therapy had a positive effect on
This also suggests alternative therapies are gaining clinical recognition collaborating with the rehab multidisciplinary team. This reflects Kobus
for supporting pain management (The Joint Commission, 2018). There et al. (2022a) study in which results shown that using music therapy as a
was a 75% level of agreement from respondents that music therapy part of an interdisciplinary practice involving physical therapy improves
provides significantly positive opportunities for dealing with anxiety/ functional outcomes. There was 87% agreement from rehabilitation staff
stress which correlates to the research done by Abd-Elshafy et al. (2015). on the positive impact that music therapy has on non-pharmacologic
Staff agreement with music therapy service outcomes, such as treating pain management and on procedural support. Due to the nature of
anxiety and stress, also aligned with parents' positive views of music music therapy often co-treating during daily therapies, these staff
therapy services (Cousins et al., 2022). A lower agreement with music members may be more accustomed to utilizing the benefits of individ­
therapy supporting siblings may be due to the COVID-19 restrictions ualized music therapy interventions and therefore view it as a service
which placed strict limitations on the number of family members at that assists in rehabilitative treatment.
bedside.
Palliative/end of life
Intensive care units
In many cases, our music therapists offer heartbeat recordings in
Intensive care is often a significant disruption in family's lives and end-of-life situations; however, families may decline this and other
services outside medical treatment that support emotional, social, and memory-making interventions for various personal reasons (Love et al.,
academic needs are becoming standard hospital services. Results 2022). There is no research regarding the perceived positive impact of

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music therapy intervention during end-of-life care from the nursing Limitations
perspective. The literature review revealed instead parent perceptions,
which aligned with the perceived positive impact indicated by clinicians The authors identified several limitations of this study. The study
(Love et al., 2022). Now, a majority of staff marked that music therapy was limited to and consisted of participants from only one pediatric
provided a positive impact for palliative and end-of-life care. NICU staff hospital within the Central Florida area. The sample size constituted
reported this more than any other unit. Perhaps parents of this popu­ another limitation with only 83 of the 193 identified and eligible staff
lation are more willing to receive music therapy interventions at this completing the study survey. As we are unaware of how those who did
stage and this may serve as a topic of further inquiry. Most all nurses not respond might differ than those who did, caution should then be
indicated music therapy to support patient's quality of life, which may used in generalizing the results of this study. Gender is another limita­
be interpreted as providing comfort care, especially to those in critical tion as all but two of the participants were female. This was not inten­
situations. ded; however, these were the healthcare professionals who voluntarily
took the survey.
Education & knowledge of music therapy services
Implications
Healthcare staff, and particularly nurses, are instrumental in coor­
dinating care for their patients. Yet, there was more disagreement that There are several implications as a result of this study. First, it is
families are aware music therapy is offered, that patients are seen often important for healthcare providers to be aware of the psychosocial
enough by music therapists, and that staff know how to provide music support services available to their patients as well as the education and
therapy with referrals. Eight in ten staff reported positive collaboration training attained by those providing these services. This knowledge al­
with music therapy, suggesting music therapists are able to coordinate lows staff members to consult the appropriate therapeutic service based
care, respect boundaries, and support staff themselves. Ensuring that on the identified needs of any patient and reassures the staff member
patient-facing staff are aware of music therapy services and availability that services are implemented safely by a trained individual. Next, the
will help patients and families receive its many psychosocial benefits perspectives of different specialties offer the chance to identify gaps in
(Robertson, 2016; Silverman & Chaput, 2011). Knott et al. (2020) sug­ education regarding the role, responsibilities, and educational back­
gests that pediatric music therapists typically cover beds at a ratio of ground of music therapists. This study revealed that many unit staff
1:100. As staff indicated that patients are not seen often enough and members expect music therapists to receive training and education to be
believe most of their patients could benefit from music therapy, our working with their unique patient populations and equipment. Further,
approximately 1:65 therapist-to-bed ratio demonstrates a greater need it is important to know who and what is always available in the hospital
for music therapy than can be met. to effectively use these resources as patients can experience stress, pain
Music therapists may feel misunderstood as they often must explain crises, and more at any time of day. This study could allow for the
the purposes of their role through formal and informal means to pa­ creation of more collaboration between music therapy and unit-based
tients, family, and staff (Meadows, Eyre, & Gollenberg, 2021). However, staff, promoting effective communication and co-treatment
this education is necessary to support sustainable care, where staff can opportunities.
generate reliable referrals and music therapists can follow patients Receiving a referral is the first component in the music therapy
throughout their hospitalization. Staff indicated a preference for virtual process (American Music Therapy Association, 2023), and therefore, the
or in-person presentations and watching live sessions to learn about quality and timing is important to the many outcomes previously
music therapy. This supports Silverman and Chaput (2011), which addressed. Pediatric staff, and nursing in particular, play a considerable
found that an in-service presentation improved understanding and role in ensuring families receive music therapy services. Music therapists
perception of music therapy benefits and services. Least preferred was primarily receive referrals from nurses, who can provide firsthand
receiving an informational flyer and knowledge of research outcomes. knowledge of their families (Knott et al., 2020). It is crucial that referrals
Robertson (2016) points to social media blogs as a useful tool for phy­ are sought to improve patient and family outcomes, such as pain man­
sicians to receive information about efficacy of music therapy services. agement, anxiety/stress reduction, engagement in therapy and medical
These preferences might suggest that more “hands-on” education may compliance, coping, improving quality of life, and addressing the many
be most efficacious to clinical staff, as presentations can be considered as mental health needs of hospitalized families. For example, the Joint
continuing education and staff may observe music therapy sessions Commission cites music therapy as an option for providing non-
while engaging in clinical responsibilities. pharmacological pain management (The Joint Commission, 2018).
Staff who work in the PICU, NICU, and in rehabilitation were more Music therapy can be utilized in a myriad of ways to improve the health
likely to indicate that music therapists should have specialized training and well-being of patients and families, but it requires the awareness
to work on these units. This reflects how the music therapy profession and understanding of the different specialties to ensure music therapy
has developed specialized training (NICU Music Therapy and Neurologic treatment is being utilized appropriately and equitably.
Music Therapy) in these areas to ensure therapists possess a nuanced
understanding of the complex treatment processes. Various reasons Recommendations for future research
were reported for the prevention of music therapy services. Staff were
concerned most with the condition of the patient, such as isolation It is an exciting time for the music therapy profession and this study
precautions, high risk for decompensation, or risk for aggressive provided a new lens in which to view it. Music therapists are essential
behavior, with several staff having concern for sensory overstimulation. members of the healthcare team, providing individualized patient-
Music therapy is not without risk of harm, as music may cause psy­ centered care and striving to reduce the negative psychosocial impacts
chological or physiological stress to a patient (Murakami, 2021). Staff of stressful and traumatic life events that require hospitalization. The
also deferred consulting music therapy to patient and parental prefer­ authors suggest that future research be conducted with regard to the
ence. Responses suggest that staff have a good understanding of when a collaboration of music therapy within the multidisciplinary team. Re­
patient is appropriate for receiving psychosocial support and positive sults showed 98.6% of staff responded agreeably to music therapy
stimulation. However, it is imperative that staff receive education from research being conducted, suggesting favorable attitude toward inter­
music therapists on the utilization of music therapy to ensure families disciplinary collaboration and implementation of protocols studying the
receive care at an appropriate time. effects of music therapy. This study can be duplicated with a larger scale
of participants and a wider variety of participant background. This may
include varying types of hospitals in different locations, varying sizes of

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Austin C. Thorn is now a graduate student at Florida State University. Ghetti, C. (2013). Pediatric intensive care. In J. Bradt (Ed.), Guidelines for music therapy
We have no known conflict of interest to disclose. practice in pediatric care. Barcelona Publishers.
Ghetti, C. M. (2012). Music therapy as procedural support for invasive medical
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Gooding, L. F., & Yinger, O. S. (2015). A systematic review of music-based interventions
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Austin C. Thorn: Conceptualization, Methodology, Data curation,
Harrison, T. M. (2010). Family-centered pediatric nursing care: State of the science.
Investigation, Writing – original draft, Writing – review & editing, Journal of Pediatric Nursing, 25(5), 335–343. https://doi.org/10.1016/j.pedn.2009.0
Visualization. Kristin Brown: Supervision, Conceptualization, Writing 1.006.
– original draft, Investigation, Methodology. Marlena Tolland: Writing Hatem, T. P., Lira, P. I., & Mattos, S. S. (2006). The therapeutic effects of music in
children following cardiac surgery. Jornal de Pediatria, 82(3), 186–192. https://doi.
– original draft. Jenna Read: Writing – original draft, Investigation. org/10.2223/jped.1473.
Kemper, K. J., Martin, K., Block, S. M., Shoaf, R., & Woods, C. (2004). Attitudes and
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Declaration of Competing Interest
intensive care unit. Alternative Therapies in Health and Medicine, 10(2), 50–54.
Knott, D., Biard, M., Nelson, K. E., Epstein, S., Robb, S. L., & Ghetti, C. M. (2020).
The authors declare that they have no known competing financial A survey of music therapists working in pediatric medical settings in the United
interests or personal relationships that could have appeared to influence States. Journal of Music Therapy, 57(1), 34–65. https://doi.org/10.1093/jmt/thz019.
Knott, D., Krater, C., MacLean, J., Robertson, K., Stegenga, K., & Robb, S. L. (2022).
the work reported in this paper. Music therapy for children with oncology & hematological conditions and their
families: Advancing the standards of psychosocial care. Journal of Pediatric
Acknowledgments Hematology/Oncology Nursing, 39(1), 49–59. https://doi.org/10.1177/27527530
211059726.
Kobus, S., Bologna, F., Maucher, I., & Gruenen, D. (2022a). Music therapy supports
The authors would like to acknowledge David Knott, MM, MT-BC for children with neurologic diseases during physical therapy interventions.
his contribution to this study and the staff of Nemours Children's Hos­ International Journal of Environmental Research and Public Health, 19(3). https://doi.
org/10.3390/ijerph19031492.
pital Orlando for their participation in this study. Kobus, S., Buehne, A. M., Kathemann, S., Buescher, A. K., & Lainka, E. (2022b). Effects of
music therapy on vital signs in children with chronic disease. International Journal of
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