Changing how the world thinks about nursing

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The best medicine in the world
 

            Music expresses that which cannot be said and on which it is impossible to be silent.

                                                                        -- Victor Hugo

Ilya Repin. Portrait of the Composer Mikhail Glinka. 1887. The Tretyakov Gallery, Moscow, Russia.January 1, 2010 -- Today BBC News posted a very good article by Jane Elliott reporting that the Florence Nightingale School of Nursing and Midwifery at King's College, London, has appointed its first "composer in residence," using funds from the PRS Foundation. During his one-year residency, composer John Browne plans to write pieces for the upcoming celebrations of the 100th anniversary of Nightingale's death and a song book for nurses to use on children's wards, among other works. The article relies on Ian Noonan, a lecturer in mental health at the School, who explains that Nightingale herself cited the importance of music in helping patients recover. Noonan's comments are generally helpful, although a couple do suggest that excellent nursing is about some intangible artistic sense and not really about science. This traditional view is understandable--nurses have long embraced the "art of caring" idea as a way to stand out alongside the physicians who get so much more respect for their expertise--but it encourages the public to continue to regard nursing as a kind of paid mothering service rather than the modern scientific profession it is. In any case, Diana Greenman, chief executive of the charity Music in Hospitals, explains that music can help "relieve pain, depression, anxiety and loneliness." Indeed, as the piece reports, music "has been shown to be beneficial in many areas of health, from stroke recovery to lung condition management." We thank Ms. Elliott and the BBC for their report on this innovative area of patient care, in which nurses have often taken the lead.

Florence NightingaleThe BBC article, "Bringing music medicine to the NHS," links the School's decision to employ the composer in residence to Nightingale herself, noting that "when Florence Nightingale wrote her seminal guide to nursing she cited the importance of music to the patient." Later, the School's lecturer Noonan explains that Nightingale

pointed out that it is important that nurses are quiet at night and don't disturb anyone, but she also talks about how familiar songs and things like Home Sweet Home or an Italian aria can sensitively soothe the sick and have the power to restore the soul.

The article gives details about Browne's planned work for the School. The PRS Foundation, "the UK's largest independent funder of new music," has made a £10,000 grant for the residency. The piece explains that Brown has done a variety of unusual musical work in the past, ranging from operas for children to some undefined work with "survivors of the Rwandan Genocide." He plans to write choral pieces for the Nightingale anniversary celebrations, as well as the children's songbook and other works. He explains:

I am being inspired by the people, the buildings and the rituals of the school and its partner hospitals - but most of all by the themes of nursing and care. On the one hand I'll be observing and responding to nursing practice on a very intimate level, and that's very moving, and at the same time I'll be looking at 'care' as one of the really big themes of our times, and of all times. They have given me a very open brief at the college, but I do want to create a songbook for nurses working with children that they might be able to use to soothe, distract or explain.

These are some intriguing ideas, and we have long encouraged people to create different kinds of art about nursing, including music, to communicate something of the nature and value of the profession to the general public. There are recent musical precedents, from songs on Country Joe McDonald's Thank the Nurse EP (2002) to Sonic Youth's Sonic Nurse (2004), but far more can be done, and Browne's approach would seem to be pretty different from those earlier works.

The one thing missing from this part of the article:  Whose idea was it to have a composer in residence at the School? Noonan's? This would seem to be a pretty basic omission, and the answer might help readers connect this innovative idea to specific persons, and if nurses were involved, help them see that nurses can make such contributions. Of course, readers will probably assume nurses were involved in the decision because it is a nursing school, but it would not hurt to make things clear.

The BBC article proceeds to get expert comment from Noonan and Greenman. Noonan explains:

Music is essential in life. People need creativity and quite often in life when they are in hospital that is lost. Everything has to be done in a standardised way and people can be very frightened if they are very unwell. It is about trying to find a different way rather than looking solely at the [National Institute for Health and Clinical Excellence] guidelines or Department of Health guidance, and about getting students to think in a more narrative way. Many people who have been nursed in hospitals find the difference between the excellent nurse and the OK nurse is not any tangible thing they do. Rather, it is the way that they do it, and that requires an art - rather than a science - way of teaching.

These comments reflect a holistic approach and are generally very helpful, especially the ones about how music can help ease the difficulties of time in the hospital. But we can't agree that the difference between excellent and OK nurses is "not any tangible thing" they do, but just "the way" they do it, informed by a sense of "art." Nurses like Noonan use clinical expertise to do many things that are very tangible, such as catching errors or subtle changes in patient conditions that can make the difference between life and death. Nurses operate high-tech health care technology, and even their psychosocial care is informed by scientific training. Indeed, though Noonan himself appears to be a musician and has developed innovative arts programs for patients, his background reveals that nursing is not just about "art," but about a distinct health science.

Noonan's current PhD studies focus on the role of mental health nurses in certain "controversial physical treatments" of patients. We can agree that nurses take holistic approaches to health care, including use of the arts, but not with the idea that nursing is all about some intangible "art" of caring, which cedes the scientific expertise that society values so highly to physicians and may encourage decision-makers to take nursing less seriously. Incidentally, the BBC piece might have included a bit about Noonan's background to show that he is a genuine health care expert.

The piece also includes comments from Diana Greenman, the "chief executive of the charity Music in Hospitals," who notes:

Live music has the power of reaching inner depths no other activity can ever penetrate. Sensitively presented music helps to relieve pain, depression, anxiety and loneliness, which is often experienced at a difficult time. It is often said that music can be the best medicine in the world.

This is all true, and as the piece also notes (without attribution), "music has been shown to be beneficial in many areas of health, from stroke recovery to lung condition management." For instance, in 2006 Japanese nurse researchers showed that patients who listened to music they liked during cardiac catheter tests had lower blood pressure. On the other hand, recent nursing research has also shown that, as Noonan notes Nightingale herself observed long ago, reducing unwanted noise in hospitals can have a positive impact on patient recovery. One such study by Mayo Clinic nurses appeared in 2004 in the American Journal of Nursing. So nursing research suggests that our auditory environment can have a powerful effect (good or bad) on our health. The BBC article might have cited some of this specific research, but the fact that it mentioned the ways in which music can be helpful to patients is commendable.

We thank Jane Elliott and BBC News.

See the article "Bringing music medicine to the NHS," by Jane Elliott, posted January 1, 2010 on BBC News.

Embedded music: LHL Handel