Music Therapy for Kidney Patients

A question from a music therapist

This is an odd thing to ask of you as a reader of an article about music therapy but for a short time please go with it.

Think back over the last 15 or 16 years of your life, or if you are old enough, the last forty years. Try and imagine the number of times you have poured yourself a cup of tea, or a glass of water because you were thirsty. Then try to imagine if each time you did so you had to weigh up whether to drink because you were thirsty or not to drink because doing so could cause irreparable damage to your heart. Now that you have done that keep those thoughts to one side, somewhere close, and read on.

I am a music therapist working for Nordoff Robbins, the largest independent music therapy charity in the UK. I qualified as a music therapist in 2013, and since then I’ve worked with children with autism and those with severe chromosomal disorders, in an oncology ward, dementia care homes and with adults who have had serious brain injury.

How we started working with Kidney Patients

Over the last two years I have also had the privilege to work with staff and patients in the largest dialysis unit in Europe. As someone who has been through renal failure and successful kidney and pancreas transplantation myself, this is of huge personal and professional significance to me.

The unit where I work is situated at Northwick Park Hospital and is one of several satellite dialysis units of Imperial College Trust. It provides haemodialysis for around 250 individual patients each week. It is the first unit in the UK to have a dedicated regular music therapy service. We have patients of different ages, different ethnic backgrounds, with different additional health issues and different experiences of dialysis. We believe one of our patients has been living with dialysis longer than anyone else in the UK – he is now in his 40th year.

Work at the unit began from discussions and plans drawn up through my conversations with Dr Neill Duncan (Lead Consultant) and Sister Claire Edwards (Head Nurse) from Imperial College Trust. In Claire’s words

When music therapy was first suggested 3 years ago I was unclear how this would work with our group of patients. We initially agreed to a trial period of just 5 sessions but after the second we knew this was something we wanted to commit to and continue. Whilst music therapy is not for all we have noticed fantastic engagement for the majority of our patient group. We have found the inner musician in the most unlikely of patients (and staff!)”

WHat the participants say

Central to the Nordoff Robbins approach to music therapy is the active involvement of clients in music making with the therapist. Active involvement includes singing, playing an instrument, moving or dancing. Listening can also be active engagement.

Offering the opportunity for patients to play and sing was something to be done carefully. It is every patient’s right to have the opportunity to be creative, to express themselves, to enjoy themselves and to have a positive effect on the environment of the ward. However it is also every patient’s right to have peace and to be allowed to rest when they need to. 

Patients’ comments reflect the benefits they have experienced.     

“The morale of everyone goes up, everyone enjoyed themselves and started talking to each other including after the session – people are always talking about it.”

“Live music is different from the radio. You feel better during the session… and then you look forward to next week.”

“It’s like if you’d walked into a lunchtime music venue… I am not at liberty to access music in the community easily, so this gives me that.”

“Sometimes I get really fed up and depressed and it [music therapy] helped me feel better after at home. I had a better, peaceful night’s sleep, and sometimes I am up until 2 with anxiety/pain/tension/exhaustion after dialysis”

The Lead Consultant, Dr Neill Duncan (Renal Consultant, Honorary Clinical Senior Lecturer, Imperial College Renal and Transplant Centre) summarises the impact of the work in the hospital in this way:   

“The contribution of music therapy within the dialysis centre has opened up new dimensions for patients and staff in their experience of care. Our dialysis centre has an even more relaxed and human feeling, people are engaged and want to be part of the music for themselves and for the pleasure of those around them. Everyone’s individuality stands out and is welcome be it banging a drum, singing a song, actively listening to another, or allowing the space for another to create in. The music takes no space and actually makes space in what was a cramped environment. Thank you.”

The Impact

Let us be clear about something. Music therapy will not reverse renal failure. In fact it does not claim to ‘cure’ or ‘heal’ any medical condition. It seeks to offer people a way to experience their situation differently which in turn can lead to very positive changes in their life.

Dialysis is a tough and constant routine which continues until transplantation is possible. When, and if that happens is completely unpredictable. The wait for an organ may be 2 months, 2 years, 20 years or indeed it may never end. Chronic kidney failure frequently brings with it problems which have adverse effects on the bones, the nerves, the muscles, other internal organs and the skin. It often leads to shortness of breath, fatigue and as a result of all of these conditions, depression. The process of dialysis may cause patients to have severe cramps and feel extremely weak. Staying alive becomes the main focus of being alive and is a matter of conscious and concentrated adherence to the discipline of rules and routines. Diet is restricted and the total permitted fluid intake each and every day is no more than one litre. Kidney failure prevents the body from producing urine and the build up and removal of excess fluid can cause tremendous stress on the heart.

This brings us back to our starting point – those years of cups of tea and glasses of water. For most of us it is no consequence whether or not we drink when we feel like it. For a dialysis patient, over time it may literally be a matter of life or death. It is just one of many things to manage and cope with.

Think of that the next time you need a drink.

Dave Thorpe BA (Hons), P.G.C.E, MMT(NR)

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