Songs in the Key of Comfort for Pandemic-Challenged Nurses

It might be true that music can soothe a savage beast, as the saying goes. But can it help lighten the emotional load for hospital nurses clocking long hours during a global pandemic? Cleveland Clinic music therapists know it can, because that’s part of what they contribute with their skills.

Emily Guthe, MM, MA, MTBC, and Stephanie Morris, MMT, MTBC, are music therapists at Cleveland Clinic Hillcrest Hospital — two of 10 who serve in hospitals across Northeast Ohio. Their work is part of Cleveland Clinic Arts & Medicine, which integrates visual arts, music, performing arts and research to promote wellbeing.

The music therapists’ work goes far beyond showing up with a guitar and a good voice, Guthe explains.

“We use live and recorded music, and we use it with full and varied experiences to really help with patients’ pain and anxiety if they’re in the hospital for extended periods of time,” Guthe says. “We are trained as musicians. We’re also trained as therapists. We combine those two experiences to help people through their hospital stay.”

They also support nurses and other caregivers, and have been especially called upon during the COVID-19 pandemic. With patients, the work often includes helping people engage with deep and difficult emotions in order to feel better. For caregivers, the support must be done in a way that allows them to keep doing their job.

“We can’t go and sing them a song, then leave them in tears in huddles and go away,” Guthe says. “So we figure out the most appropriate thing that we can do for them while they’re at work, or we give them tools to take home for when they’re ready.”

Professional boundaries are important too, Morris adds. “We want to support their mental and emotional health in a way that isn’t making us their therapists, but still uses our skills as music therapists,” she says.

That might begin with a question, as it did one day when Guthe encountered a nurse she knew – a prevailingly upbeat person — who seemed to be struggling with stress from an especially difficult day. Guthe asked the nurse if she needed time to step away and learned that she was on her way to lunch. So Guthe offered her a song. The answer was yes, and the two went into a break room together, where Guthe played some music for the nurse.

“The challenge is that she was tearful on her lunch break,” Guthe says. “The positive thing was that she needed and wanted the music. She could have said no, and I would have respected that wholeheartedly, but she was open to it. By the end, we were talking and she was laughing and she said, ‘This was exactly what I needed.’ And she was ready to go back to the floor after her lunch break.”

“She is an amazing nurse,” Guthe adds. “It just took that 20-minute timeframe to get her back into a headspace where she could do her job the way she wanted to do it.”

Using tools of music therapy to aid colleagues

Bringing music therapy skills to caregivers requires balance. “There’s this a very careful delineation of giving that space for the nurse to express emotion, but not delving into the deepest, darkest feelings in that moment,” Morris says.

Morris recently was asked by a nurse to “just walk around and sing on the unit. She wanted holiday music, so she could sing, too,” she says. “Sometimes that interaction, having people participate in the music, can have such an impact.”

The therapists also have done other projects with nursing caregivers. Recently, a Hillcrest PCNA expressed a wish to sing for his coworkers. The therapists helped him sing and play the music, which was recorded and then shared by e-mail with his team. The project helped reinforce the caregivers’ connection to one another when COVID-19 has made that difficult.

Working virtually, as the music therapists have had to do during some of the toughest days of the pandemic, has challenged their creativity. Early on, Guthe sent out a new tune each week to caregivers of the neonatal intensive care unit, calling it “NICU Music Mondays.”

“I’d send them a song and say ‘Here’s this week’s song, and this is what the sentiment is.’ A lot of them were about how to keep going forward.”

NICU staff also would request songs for each other, which Guthe would record and then email to the recipient with a message of care from the sender.

There have been little streaming concerts during which caregivers could take turns stopping in a conference room and request songs, which the therapists — still working remotely — would play for them. The therapists also are present at ceremonies, including a recent remembrance of those who have died from COVID-19. And they made a Youtube video performance of Andy Grammer’s song “Don’t Give Up on Me” to honor healthcare workers.

How to use music with intention

People who love music use it in all kinds of ways, but it doesn’t always serve as therapy. For music to be helpful in a difficult moment, consider using it more intentionally, Guthe says. Listening to calm music in hopes that it’ll eradicate anger, for example, might just add frustration.

“You need something that’s going to help you to feel the anger first, before you can get to more to the relaxed state,” Guthe says.

Instead, try this.

• First, assign a level of intensity to your mood. On a scale from one to 10, how intense is your anger, sadness or stress?
• Next, think of a song that matches that intensity. If you rated your anger at seven, think of a song that feels like a seven. “That song is going to be different for everybody,” she notes. That “seven” song will be the first on your playlist.
• Next, identify a song that feels like a six, a five, a four and so on. “Your playlist will probably be about 15 minutes long, and listening to it will help you transition from that seven to the one,” Guthe says. “It’s not going to fix things every time, but it might help you to work through it. This is actually something I do with patients a lot to work through their feelings.”

It’s also important to build in time for silence, the therapists say. “Hospitals are really noisy environments and can be very overstimulating at times, both for patients and caregivers,” Morris says. “Sometimes taking time just for quiet is very helpful.”