Essay: Music therapy reduces anxiety, depression and agitation amongst dementia patients

Introduction
This assignment’s purpose is to critically evaluate 5 articles above by comparing how the researches were conducted. Nursing and Midwifery Council (NMC) (2015) encourages nurses to deliver care based on evidence based practice. The assignment will look at how effective music therapy is to dementia patients, according to British Association for Music Therapy (BAMT) (2018), music therapy engages healthy parts of the brain in order to address the secondary effects of the illness, such as loss of confidence, low mood, feelings or frustration, irritability and anxiety. A fundamental goal of nursing research is to develop nursing care and outcomes by basing care on sound evidence (Elliot et al, 2012) beginning with the believability factors.
The Believability aspects of the 5 articles reviewed
Author; Do the researchers(s) qualifications/position indicate a degree of knowledge in this field? The 5 articles chosen were all published in health related journals. The authors all state to have a background in fields relating to health or music. According to Ellis and Standing (2016) checking the authors’ credentials involves understanding of at least one of the three main areas: their qualification, their current or past work roles and their publication history. Although Coughlan et al., (2007) argues that the credentials are not as important as quality of the research itself as researchers have to start with a first paper and therefore limited publishing credentials
Is the title clear, accurate and unambiguous? Does the abstract offer a clear overview of the study including the research problem, sample methodology, finding and recommendations? The 5 articles present a clear title that lets the reader to grasp an understanding of the topic. In addition, as Ellis and Standing (2016) states a good title will identify the characteristics of participants, nature of research question, the
methodological approach and results.
However, articles 2, 3, 4 and 5 uses the word abstract to clearly notify the reader of the aims of their studies, article 1 shares information which allows the reader to see the objectives clearly. It also has a descriptive, title that clearly states the study is based on the importance of music for people with dementia. The objectives clearly state the study explored the meaning of music in the lives of people with dementia.
Article 2 clearly included in their abstract, how they explored the benefits of singing on the health and well-being of dementia patients and their carers.
Article 3’s abstract clearly introduces the concept of Music therapeutic caregiving (MTC) as an intervention aimed at elucidating the therapeutic benefits of music on the patient-carer relationship.
Article 4 has the background and method clearly stated in the abstract. In addition, Article 5’s abstract clearly states the topic , exploring the effects of live music concerts on the well-being of Dementia patients, their carers, families and healthcare providers. This makes it easy for the reader to read.
Writing style; Is the report well written-concise, grammatically correct, avoid the use of jargon? Is it well laid out and organised? The articles either used an introduction or background to describe the nature of the study.
All the five articles were laid out and organised making it easy for the reader to understand.
Sub heading and quotes are used to provide content and were made easier for the reader to read, headings for main sections are made short and meaningful (Royal College of Nursing, 2017) (RCN). However all initials written are to describe aspects of practice or organisations followed by a full description without any unnecessary jargon used, the definitions were given for variables under inquiry.
Framework
There are different frameworks that are used to critique however; this assignment has chosen the Critical Appraisal Skills Programme (CASP) to critique all 5 qualitative articles. Wood and Ross-Kerr (2011) and Munhall (2012) explains critiquing as a way to seek a study’s strengths, weaknesses and the reliability of its findings.
The resources and the critiquing frameworks cited recommends to make a judgement on the robustness of the work under scrutiny. It is important to focus on the degree to which the design of the research matches the purpose of the research, and ensuring the process was carried out in transparent or scientific manner in order to produce a coherent argument for the conclusion (Baker, 2017).The paper will discuss some key strengths and weaknesses of each paper.
Article 1 by McDermott et al., (2013) was a qualitative four-phased design which was carried out using focus groups and interviews. The strength of this study was its qualitative nature through the use of focus groups in developing further insights into the musical experiences of people with dementia. Hennink (2014) states how useful focus groups are; for gaining detailed information about personal and group opinions, feelings and views. Therefore, qualitative methodology was appropriate in this study; as thoughts and opinions of people were gained through the interviews and focus groups hence fulfilling the recruitment strategy. Although, Harvey and Land (2017) argue that focus groups are not an appropriate method of data collection for some sensitive challenging topics. However, focus groups have promoted usefulness and validity by having participants feel relaxed and freely communicating their views, ideas and opinions (Stewart and Shamdasani, 2014). An inductive approach was a strength promoted by Thomas (2014), chosen to analyse data in article 1, this is a systematic procedure for analysing qualitative data in which the analysis is likely to be guided by specific evaluation objectives. However, McDermott et al., (2013) argues that the main purpose of the inductive approach is the rigorous systematic extraction of data and description of themes and categories that are most relevant to research objectives. The study however had some limitations as the sample representation was not represented equally in numbers within the article they state, the focus group participants were only limited to 15. Out of the 44 families contacted only 15 agreed to attend the focus groups and the rest did not attend. As argued by Coughlan et al., (2007), that small samples are usually at risk of being overly representative of small subgroups within the target population. Therefore, the results of this small sample cannot be valid, as it is not a true reflection on the experiences of a wider population. Ethical approval was informed and granted. Holland and Rees (2010) states data collecting is not a right of the research, but an activity that requires permission ensuring it is acceptable.
Article 2 was qualitative study by Osman et al, (2016) this design utilised a semi-structured interview approach to evaluate ‘Singing for the Brain’ (SftB) – a psychosocial intervention implemented by the Alzheimer’s Society (2003) to improve quality of life and enhance social engagement amongst patients and their caregivers. A clear general aim of the study considered understanding the attitudes and experiences of patients or carers, it is evident that a qualitative approach was the ideal methodology for addressing the research goal (Teherani, 2015). Although the reasoning behind the use of semi-structured interviews was not eluded in the study, the benefits of this interview format have been extensively documented within the literature. According to McLeod (2017) a semi structured interview is the most widely employed interview format for qualitative research and can occur either with an individual or in focus groups. The individual semi-structured interview allows the assessor to delve deeply into social and personal matters, thus allowing for a thorough understanding of patient perceptions related to the topic of interview (DiCicco‐Bloom, 2006). However, Creswell (2014) states the disadvantages of qualitative research conducting interviews, as they can be very time consuming. This approach, however, differs from article 1 and has such offers insight into the differences between individual vs focus-group interviews. There was emphasis on the acquisition of ethical approval and valid patient consent. There is popular sentiment amongst the research community that research ethics approval processes can be bureaucratic and frustrating (Creswell, 2014). Despite this, Newson (2015), argue that in addition to mitigating harm and inferring legitimacy to clinical research, the process of obtaining ethical approval also improves the quality of the intervention being investigated. Furthermore, the data collection strategy used within this study proved to be a notable strength. In line with Braun & Clarke, (2013) transcripts, within this study were subjected to thematic analysis thereby facilitating the production of inductive and deductive findings. According to Bryman (2016) thematic analysis allows the researchers to scheme through the information so they can make sense of it. Interviews were recorded to guarantee accuracy of data and the interviews were undertaken by the same assessor to ensure continuity and uniformity of the data collected. Notwithstanding the overall good quality of this study, a significant point of criticism and future improvement was the lack of diversity in the musicians provided and in the study of participants. Augmenting the sample size to cover patients from various ethnic backgrounds may potentially have added more depth and validity to the study. However Bryman (2016) mentioned that increasing a sample size decreases the sample errors. Similarly, it would have been interesting to explore the effects of different musicians on the study results. Also participant’s ethical approval was informed and granted.
Article 3 by Hammar et al., (2010) applies a qualitative approach exploring the effect of music on the interaction between dementia patients and their carers. The abstract clearly introduces the concept of Music therapeutic caregiving (MTC) as an intervention aimed at elucidating the therapeutic benefits of music on the patient-carer relationship. Unlike the study carried out by article 2, however, the method applied was an unstructured group interviews conducted in which caregivers were presented with open-ended questions to assess their caring experiences with or without MTC. These were further followed up with specific probing questions to steer the interview towards the aim. However, Bryman (2016) states open ended questions answers must be coded and time consuming as participants are most likely to talk longer, replying however they wish. On the other hand, Corbin (2003) promotes this style of interviewing as beneficial in long-term field work as this allows respondents to express their views within an unbiased setting. Furthermore, as previously alluded to in article 1 group interviews are cost and time effective and often permit for the comfortable sharing of information and development of focused conversation (Creswell, 2017). Hammar et al., (2010) also offer justification for their methodology stating that people “often need to listen to others” opinions and understandings to form their own”, thus ‘enriching’ the interviewer’s content. As the focus of the study revolved around the exploration of individual experiences, one can infer that a qualitative model was ideal in addressing the research goal. In this regard, parallels can also be drawn between this study and those by Article 1 and 2. Conversely, unlike article 1 study, due consideration was made regarding the researcher-participant relationship and its effect on the study results. In comparison, this aspect undoubtedly portrays the commendable quality of the study undertaken by Hammar et al., (2010) strengths aside, various aspects of this study may still require further research. In particular, the effect of language barriers between carers and patients could have been considered to provide an extensive analysis of the study aim. With reference to the work undertaken from article 1, 2 and 3 much has been garnered from the ameliorative effects of music on dementia patients and their carers. Despite such extensive literature on musical therapy within the community, little attention has been afforded to its use within the acute hospital setting. The caregiver struggled to maintain good ethics due to the aggressive participants.
Article 4 by Daykin et al., (2018) employed a mixed method analysis to satisfy the research aim. As described by Johnson et al., (2007) the mixed method is one of the three “research paradigms” (alongside quantitative and qualitative) often favoured for the generation of superior research findings and outcomes. Claydon (2015) states how quantitative research can be explanatory and deductive with numerical data being collected to test a theory, Differing from qualitative research that can be exploratory and inductive collecting narrative data, generating themes that the researcher may use in developing a theory (Sim and Wright, 2000). In contrast with the articles outlined above, this methodology seamlessly allows for the multi-dimensional analysis of musical therapy in Dementia, thus reinforcing the strength of the study. The study seeks to amend this paucity of data on the use of non-pharmacological approaches within the hospital. Whilst concurrently addressing issues regarding patient quality of life (qualitative component), this study also examined the potential impact of music on length of clinical stay, falls and patient behaviours (quantitative component). A clear sampling framework on the ward level data was collected from 85 patients with a Dementia diagnosis who had resided on the wards during the study period. These results were obtained over two separate 10-week time periods which were subsequently compared to determine effect. However, despite the results a significant hindrance to study validity was the presence of various confounding factors and the lack of a control group. On a quantitative level, aspects such as age, severity of disease and routine changes in clinical protocol may have adversely affected the results obtained (Serkova et al., 2011). Similarly, the nature of the participants studied further raises questions regarding the qualitative data obtained from interviews and consultations. Such considerations ultimately warrant future research. Nevertheless, unlike previously referenced work, this study demonstrated the value of innovative mixed methodology in the assessment of music therapy amongst Dementia patients. Moreover, it further scrutinised these effects on the clinical environment; an angle not yet explored by either article 1, 2 and 3. The study obtained its ethical approval for the participants and informed consent (Daykin et al., 2018).
Article 5 by Shibazaki et al., (2015) is a qualitative design succinctly contributing towards this body of knowledge. It concurrently addresses the limitations expressed by article 1 namely the qualitative assessment of family members and healthcare professionals. Contrary to previously acknowledged articles utilising a single research location, a clear sample was undertaken by Shibazaki et al., (2015) simultaneously analysing two separate participant populations. This included a total of 22 concerts (11 in England & 11 in Japan) were carried out with a series of semi-structured interviews conducted following each concert. The use of semi-structured interviews has also been advocated by Harvey et al., (2017) as a strategy towards more comprehensive responses from the interviewee. Open ended questions were used as stated by Bryman (2016) they ensure that responses are voluntary and relevant to the topic being evaluated. However, Hulley et al. (2013) argues that open ended questions require coding, and participants are more inclined to take longer, replying however they wish. This caters for differences in cultural perceptions to music and mental health, thereby conferring depth and validity to the study. Intuitively, a qualitative methodology was employed to analyse participant perceptions and experiences. Findings demonstrated an increased level of cooperation and interaction from dementia patients as well as an elevated sense of well-being from family members and carers. Conversely, a major limitation in the study was the timing and context within which the interviews were carried out. As consultations were undertaken immediately following the concerts, it could be argued that respondents may have still been experiencing temporary levels of euphoria, thus permitting unintentional bias in their responses (Shibazaki, et al., 2015). Regardless, this data remains promising in the field of non-pharmacological dementia care and could possibly pave the way for extensive future research. Additionally, an ethical approval from the University and consent by participants was granted.
To conclude, this assignment proved a unifying view that music therapy is pertinent to the reduction of anxiety, depression and agitation amongst dementia patients. All articles analysed employed a qualitative approach to meet their shared research aim exploring perceptions and opinions of music therapy. However, article 4 utilised a mixed method analysis thus augmenting their study with respect to data validity and depth of content. In all, these studies demonstrated a strong inclination towards music by clinical and care staff who perceived it to be therapeutic to the wellbeing of dementia patients. Future research in this field of study promises a wealth of knowledge pertaining to the use of non-pharmacological approaches in the care of patients with Dementia.