music holds the key...|
My first week at Tacoma Lutheran Retirement Community primarily consisted of training, which will set me up to work more independently. At our first meeting on July 12 th we established what I will be doing during my time here and a schedule. Megumi, the music therapist, gave me administrative tasks to take home (correcting documents and creating a spreadsheet where we can input data from patients) to help the program function smoothly. This week I had been working alongside Mercedes for training, who works in the life enrichment program. I began to familiarize myself with the residents taking part in the Music and Memory program. I had the opportunity to interview residents who were potential participants. This included explaining what the program is and getting to know them and their musical preferences. On Thursday Mercedes showed me the equipment we will be using and I began creating playlists for the new participants. Next week I am going back to begin the distribution of the equipment to the residents. I will have a form that I fill out to describe how the resident reacts to the music playlist. Although I had been working around Mercedes' schedule this week, I hope to gain a more consistent schedule after next week, as I will be more trained and can work more independently with the program.
7/30 - 8/2/2018
This week at Tacoma Lutheran we have been adding more participants to the music and memory program. When I started, we were just at 9 residents, and now we have 14 who agreed to participate (and more coming hopefully). This is exciting to me since for different reasons, it has been difficult to find willing participants for the Music & Memory program. When we do get a new participant, I get to know them and often they have a hard time remembering which artists they liked. The "Music Matrix Sheet", which is a document with different genres and artists, has been a huge help in sparking some of the musical memories of the residents. Many times, I'll say a name off of the list and then a resident has a story of their own personal connection with that music or artist. This has been a huge help in constructing these personalized playlists for residents. When I first became introduced to this program, I thought it would've been only for people with dementia or memory loss in general. Since I've been here, I've seen the program being used for more than just that. Music has been used here as a tool to help people who suffer from pain and people who are non-verbal on top of aiding with memory. So far, I have seen people who suffer from tremendous amounts of pain begin to smile again, and even let out a giggle. I was even shocked to see a resident who is non-verbal begin to hum to the music and try to sing along to a Johnny Cash song. The results we are getting as we get further along into the program have been much more than I expected.
8/6 - 8/10/2018
These past few days have been busy. On Tuesday, I really focused on trying to see some of the residents whom I haven't worked with yet, just so I can be familiar with everyone. One participant noted how lovely that it was because it took her back to her childhood, and that everyone in this facility should have a music player. After meeting with the Music Therapist Thursday, I got more clarity about the work we were doing. We decided to revise a few things so that we can better analyze how the program is working. Instead of just documenting on the patient response sheet (which is how we document how the respond on a scale of 1-10 on different aspects) during the session, I rearranged the sheet, so we can do a before and after scale. We would put how agitated they seemed at the beginning of the listening session, and then how agitated they seemed after the music session. I hope that this small change will help make the effectiveness of the program clearer. Since we now have 15 residents participating in the Music and Memory program, we decided we would need more volunteers to accommodate this increase. We are aiming towards visiting each participant at least once a week with their playlist. Once we get a few more volunteers, we hope to expand to Alpine, which will be more geared towards working with people with severe memory loss.
8/13 - 8/16/2018
So far, we have been adjusting to the updates we decided to make for the Music and Memory program. With 15 residents that have been willing to participate, it has been busy trying to make sure that everyone has gotten equal time with their personalized playlists. On Tuesday, I spent time with Mercedes re-designing the flyer for the program that will be put around the building to advertise to the residents and their families. This is great timing for this to be done since we will soon expand to Alpine, the dementia and Alzheimer's unit. Our hope is that there will be family of the Alpine residents interested in signing them up for the Music and Memory program. After spending time watching some of Teepa Snow's videos, a dementia and Alzheimer's care expert, I have been better prepared to communicate with the residents in Alpine. I was also at the facility on Wednesday, which was spent going out to get more visits in with the participants. This was my first time using the new Patient Response form that we designed to compare the beginning and the end of the music session. From my experience with it so far, I believe it will highlight how effective the program is, especially at improving a resident's mood and agitation levels.
End of summer 2018
Wednesday I was walking around the facility looking to see who would be available to listen to their playlist. I spot one of the participants sitting in the hallway by her room. Trudy (not her real name) was one of the first residents to sign up for the Music & Memory program. Her playlist is a mix of Benny Goodman, Frank Sinatra, and some Glenn Miller. She loves swing and jazz, as she grew up in the 30s-40s era. Each time she listens, there's always a consistent physical reaction like foot tapping and rocking back and forth. When I ask her if she would like to listen to her music, she always replies in ways that don't make much sense. Regardless of this, she does accept. On Wednesday I noticed something different in her once I placed her headphones across her ears. She began smiling and nodding, and I ask if the volume is good for her. She replies with, "It's lovely!". This was surprising because she was making sense to me finally, and she became very aware of what was going on around her. After staying with her for a few minutes, I tell her that I'll be back to check on her. I go back to the room where the life enrichment staff work on the computer. As I'm working, out of the corner of my eye I see Trudy scooting her wheelchair down the hallway to the music. She seems to be more willing to move around when she has her music on. When I check back on her, the nurse tells me how great this music is for her, as it gets her moods up, and gets her moving around on her own.
9/24/2018 - kitchen band
One of my first days back there was something called "kitchen band" in the chapel, which is like karaoke with hand-held instruments like a tambourine. Kitchen band is an activity that occurs frequently, but I was surprised with the number of residents participating. Even residents from the Alpine unit came out and sang along. The chapel filled up with great energy as everyone sang along together. Many of the residents are experienced singers. All morning long, the halls were filled with the voices of residents harmonizing together. I couldn't help but to analyze the different reactions from activities involving music like today versus having the solo experience of a music player. Everyone in the chapel seemed joyous and interactive with each other and the music. When I see these same people listening to their personalized playlists, it seems to be a deeper, more personal experience. From my perspective, both experiences are meaningful and are helpful in bringing joy and keeping the minds sharp of these residents in different ways.
Since I started at Tacoma Lutheran, I was curious how music has helped agitation and behavioral issues. While watching one resident, I understood more about how music can improve moods. I see agitation as a natural response to the environment that often looks like frustration. Sophia (not her real name) had occasional episodes of agitation, that were visible in the things she said and her body language. She didn't like anyone hovering around her. Other than that, she's extremely kind and soft-spoken. I have watched her since I had started in July and over time I have seen a change in behavior. I think that this is partly the music working, because of the sudden change in her after her implementation of music. She is a big fan of classical, opera, and some soundtracks. When I visit her, she usually is sleeping in her wheelchair. I tap her and ask if this feels like a good time to listen to some music, and then I throw in that I just added the soundtrack to The Sound of Music to her playlist. She always accepts with enthusiasm, even though she doesn't seem fully aware of her surroundings yet. After I place the headphones on her and adjust the volume, she starts heavily tapping her foot and nodding her head. Then I notice that after listening for a few minutes, becomes more aware of her environment. She usually isn't too bothered with what's going on around her, but this time I found her looking around and trying to engage with others. Every time someone would walk past her, she would say "hello" with a smile. I tested this by walking past her a few times, each time I still got a "hello". I would like to believe that the music does something good for Sophia. I am convinced it is bringing her joy each time she listens, and has improved her mood overall.
On Thursday I went in to Tacoma Lutheran to do some music visits with residents that I hadn't met or hadn't seen in a while. Mary (not her real name) seemed very aware and still sharp when I first met her. Over the past few weeks, she seemed to decline a bit - less awareness, more confusion. When I first greeted her today, she seemed a bit disassociated with what was going on. Overall, Mary seemed gloomy. She was preoccupied with thoughts about leaving the facility or cooking for her family. I had seen something like this in a Teepa Snow video, so I knew what to try. Since she mentioned cooking, I went with that and asked her for advice on cooking and recipes. I wanted to acknowledge how she was feeling and show her that I was listening, but also to deflect and give her a task to think about. We kept the conversation going even after I gave her the music, with one side of the headphones slightly off her ear. I was surprised that even with her being less aware, she had a high amount recognition with the music. She could name the songs and artists, like Aretha Franklin and Stevie Wonder, which lead to different stories she would tell me. I think that her music helped not only to calm her down and take her mind from other things, but also helped her remember stories that she could then tell me. I told her I would be back on Monday to hear more stories.
I'm more impressed each time I see how personalized music has helped those residents who are nonverbal. One of the residents has had problems with nonstop crying throughout the day. In the past several weeks I had been working with her, I have had at least three different nurses tell me how much of a difference the music has made for her. From what I know, she has a rich past rooted in music, and attended many concerts with her husband. She loves The Beach Boys, Johnny Cash, John Denver, Fleetwood Mac, and many others. The nurses tell me that when she has her music she will almost immediately stop crying. I see in her an increased amount of initiating eye contact and facial relaxation. It has been more challenging recognizing these differences in residents since I have a limited perspective. The nurses have eyes everywhere and are much more familiar with the residents' behaviors. Working with the nursing staff and sharing their perspective has supported not only me, but also the Music & Memory program immensely throughout this process. I have faith that eventually the Music & Memory program will be smoothly integrated into Tacoma Lutheran's nursing staff.
This morning when I had arrived, I noticed about half of the music and memory participants were in the chapel participating in Kitchen Band, a karaoke type of sing along for the residents. They had songs from different eras with the lyrics on the big screen and hand-held musical instruments for everyone. The songs that came on ranged from slower tunes to blues to rock and roll. Some of the Music and Memory participants who do not have much reaction to their music players and headphones, had more of a reaction with music during Kitchen Band. Specifically, residents who came that were a part of the Alpine hall seemed more engaged than they usually do with just their music players and headphones, as I saw them singing along for the first time and using the instruments that were passed out. At the same time, some nonverbal residents who reacted better to their own individual experience with their music player didn't seem to enjoy Kitchen Band as much, as they didn't seem as engaged or relaxed. I could see how for different residents, it could be an over stimulating environment. Overall, I think most reactions were wonderful and the energy in the room felt good to start with. After we hit maybe the 20-minute mark of the hour-long activity, the residents' attention began to drift elsewhere. I can conclude that residents benefit from these musical activities. It would be interesting to see new creative ideas for activities that incorporate music for the residents.
While comparing two different music sessions with the same resident, I see a vast change already. The first time that I approached Alma (not her real name), she was very quiet. I was finishing up her music matrix sheet to see which artists she liked the most so that I could make her playlist. She selected quite a few from different genres, mostly "crooner" types. The first time she listened, she took the media player reluctantly and listened for a few minutes. As soon as I stepped out for a moment, she took off the headphones at the table and went back into her room, not saying much more. Today, I went back to see Alma for a second time and saw a completely different response. She was just waking up from a nap when I asked her if she would like to listen to some music. She said yes immediately. After a few minutes, it seemed as if she was enjoying it, tapping her foot and smiling. When I came back to check on Alma, she seemed much more interactive and engaged with her environment. She was sitting at the table with other residents and coloring, and her smile was lighting up the whole room. I asked if she was enjoying the music, and she seemed incredibly enthusiastic this time. She enjoyed it so much she was not ready to be done listening. I am not sure what caused the differences between the first time and now, but I hope to spend more time getting to know Alma and how the music is helping her.
This week at Tacoma Lutheran I was able to visit most of the residents that take part in Music & Memory. There were two that had not listened to their playlists yet since one is a newer participant and one had always declined in the past. The second seemed very open to trying to listen today, so I must have caught her in a good mood. She is bedridden, so she couldn't get up and dance, but if she could have then I believe she would've been dancing away in her room. The playlist mostly comprises of Elvis and other rock & roll oldies, so we started off right away with an Elvis song. She started moving her lips to the words of the song and tapping her feet. Doing this little activity seemed to completely elevate her mood, especially since she doesn't leave her room often. She never said much the last time that I visited her, but this time was completely different since she seemed willing to talk. At the end of this session, she told me that the music was just wonderful, and that she loved to hear some of her favorite songs. One of the best parts about this program is watching the reactions from a resident the first time listening to their playlist. I am curious to see how the next few music sessions will help. Next week I plan to visit residents who have not yet joined the program since we have room to add on.