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In the medical environment, surgery and procedures are tools for diagnosing or treating disease and illness. Surgery is the branch of medicine that deals with the diagnosis and treatment of injury and illness through manual and instrumental means (Webster’s New World Medical Dictionary, 2008). Medical procedures are categorized by the level of invasiveness and are termed noninvasive, minimally invasive, or invasive. Noninvasive procedures refer to those that utilize external imaging, such as x-rays, magnetic resonance imaging (MRI), computerized axial tomography (CAT) scans, and positron emission tomography (PET) scans. A minimally invasive procedure refers to a procedure that is less invasive than open surgery used for the same purpose. In a minimally invasive procedure, there is minimal damage to biological tissue and the damage that does occur is typically from the insertion of the instrument. Medical procedures that are invasive refer to medical procedures that invade the body, by a device that punctures the skin or an instrument that is inserted into the body (NIH, 2012; Webster’s New World Medical

Dictionary, 2008).

There is a wide array of noninvasive, surgical, invasive, and minimally invasive procedures performed in medical care. These can range from open-heart surgery to cardiac catheterization, labor and delivery, radiation, gynecological exams, burn debridement, wound care, mechanical ventilation, biopsy, dialysis, and a host of others. Patients who experience high levels of anxiety can encounter the negative physiological symptoms, such as increased blood pressure and heart rate, elevated blood cortisol levels, and decreased immune response, which can result in slower wound healing and an increased risk of infection (Scott, 2004). Additionally, patients undergoing medical procedures may have negative experiences or symptoms as a result of their reactions or feelings about the experience or as a result of the invasiveness of the procedure itself. Patients may have fear about undergoing the procedure and experience stress, anxiety, pain and/or discomfort during the procedure.

Music therapy for surgical and procedural support can occur prior to, during, or following the surgery or procedure. Music therapy is a versatile approach with flexible methods that can address the various needs, symptoms, and feelings that patients experience in the perioperative and procedure process. This can range from managing stress and anxiety due to anticipation of the procedure to distracting the patient from fears or pain, facilitating relaxation to manage discomfort or anxiety, or managing symptoms such as nausea. The intensity of these feelings, symptoms, and issues can vary depending on the invasiveness of the procedure, previous experiences of the patient, and the patient’s ability to cope.

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Patients may undergo many different procedures during the course of their hospitalization or treatment. The level of invasiveness varies tremendously from one procedure to the next, and a patient’s response may vary from one procedure to the next as well as from one patient to the next. Therefore, it is important to approach each patient based on their circumstances and situation, and to individualize their care. It is important to be observant of body language, facial expression, muscle tension, how they may be positioned, and vital signs, in addition to what a patient may say. It is important to pay attention to details, as all of these are sources of information about the patient and provide indications of the patient’s needs.

Patients may not always know or be able to communicate clearly what they need, due to their condition or situation. They may also feel too overwhelmed to even recognize what they need in the moment. This can require the music therapist to assess their needs and introduce the intervention that is potentially the most effective. It is important to ask if the patient does consent to the intervention.

Patients can have a wide range of needs that arise during procedures. Physical needs can include dealing with pain and discomfort, nausea, and increased respiratory or heart rate due to stress or anxiety. Emotional needs may include anxiety, fear, or depression prior to or during the process. Some patients may have spiritual needs to be addressed in this process as well. They may want to feel more connected to God or their Higher Power during this time. In order to best meet these needs, it is helpful to meet with the patient in advance to assess these needs.

Patients who have had previous experiences in undergoing procedures may have a clear understanding regarding how they tend to respond in these situations, or they may have a greater level of comfort due to their familiarity with the process. While this may be very helpful to the music therapist in anticipating their needs, the music therapist still has to be prepared to respond to needs arising in the moment. Previous experiences of the patients with a particular procedure do not guarantee that they will experience it again in the same way.

It is also important to understand what the patient can and cannot do during the procedure. If the patient needs to be still and not move, they will not be able to actively play music. Additionally, it is important to know what access the staff doing the procedure needs to have to the patient. This helps to ensure that an instrument will not be obstructing the procedure and provide insight into how to situate for the procedure to best meet the patient’s needs.

During the course of the intervention or therapeutic process, the patient’s needs may change. This may necessitate shifting or changing the intervention accordingly. For example, a patient may begin a session by needing active music-making to provide distraction from discomfort. After a period of actively making music, he or she may tire and need to move to an intervention in which they engage in a receptive method. Therefore, it is important to continuously observe the patient’s level of engagement and body language to best access their needs and changes therein.

Musical characteristics for this clinical population will vary in many ways. Adults undergoing surgical and medical procedures range in age from late teens/early 20s to older adults well into their 80s. Music preferences for patients in these age ranges will vary greatly, and assessing these preferences will be key to meeting the patient’s needs. It is important to be aware that the musical needs of the patient may vary during the procedure, thus requiring the music therapist to be flexible while engaging the patient in the music experience. There will be times when the patient needs very soothing and calming music (based on their preferences) to help them relax, and then in the midst of the same procedure they may need music that serves as a means of distraction.

It is helpful to have a variety of instruments for playing live music for patients during a procedure. This ensures that the patient can make a choice regarding what they would like to hear from moment to

moment. When patients are engaged in actively making music, it is important to have a variety of instruments that can be easily played with minimal effort, as the patient may not be able to move a great deal due to the procedure. Sound can also be a consideration, so it is important to have instruments that can also be played quietly and softly in order to not disrupt the staff conducting the procedure or other patients in surrounding rooms.

In the medical environment, there are precautions to follow. Instruments need to be cleaned prior to and after procedures. Ensure that the instruments you will be utilizing with a patient can be cleaned with the wipes utilized by the hospital to sterilize equipment. This may require checking with the manufacturer. Hospital gowns, gloves, and masks will often be required. Observe signs outside patient or procedure rooms, as these will indicate the necessary precautions. Procedures often occur in smaller rooms, so it is important to work with the patient care team to determine how to best situate care providers in the space to provide the best possible patient care.

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Music therapy referrals are often a multipronged process involving patient self-referrals, treatment team referrals, and/or music therapist–based referrals. During their scheduling, patients may be given information in advance regarding services available to them before, during, and after the procedure. In this instance, they have the opportunity to self-refer for music therapy. On the other hand, a nurse meeting with the patient to discuss the procedure may suggest or make a referral for music therapy services. As the need for procedures can arise quickly in the medical setting, the music therapist may be paged when the nurse or physician recognizes that music therapy services may be helpful to the patient. Last, music therapists may suggest the service to the patient or the treatment team for certain medical procedures or symptom presentations.

Once a patient has been referred for services, the music therapist should assess music preferences and how music will be used during the medical procedure. It is important to determine if the patient is restricted to music listening or if they may be engaged in simple or subtle playing or singing. A sample music assessment tool (MAT) developed by Chlan and Heiderscheit (2009) is included in Appendix A. This tool can assist in assessing the music preferences of the patient.

There are many considerations when utilizing music and music therapy in the surgical or procedural process. This requires understanding the procedure and what logistically will occur, as well as the needs of the patient and staff. These factors all impact the process and need to be reviewed so that the procedure can be conducted successfully and smoothly. It is important to consider the following when determining what method to employ with a patient.

• An understanding of the process surrounding the procedure: o What precautions need to be taken for this procedure?

o Does the patient have any experience in undergoing procedures? o If so, what has been helpful in the past?

• What are the patient’s needs?

o Has the patient expressed any fears or concerns regarding the procedure? o Could these needs change during the process or course of the procedure?

• Does the patient have a clear understanding of the procedure (what will take place and how it will occur)?

o Does the patient want to understand what will take place in the procedure? • How does the patient tend to respond when feeling stressed, anxious, or overwhelmed? • What are the patient’s music preferences?

• What is required of the patient during the procedure?

o Is the patient able to move, or does he or she need to be still?

• What are the space considerations and needs of other staff during the procedure? o Will family members be present during the procedure?

• Does the procedure staff understand the role of the music therapist?

o Does the procedure staff understand the role that music can plan during the procedure?

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The following methods and procedures are most commonly used for surgical and procedural support. These have not been sequenced to reflect relative significance, effectiveness, or complexity.