Nursing Theory for Music Therapy Quality Improvement Program

Theoretical Framework

 The use of theories, models and frameworks are crucial in any implementation project. They aim to describe or guide the process of translating the research into practice, explain what influences implementation outcomes and evaluate implementation. According to the definition, theoretical framework provides a general representation of relationships between things in a given phenomenon. With that being said, for this project, the two nursing theorists that I chose to help guide me in designing the music therapy quality improvement program will be Katie Eriksson and Katharine Kolcaba.

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Katie Eriksson – Theory of Caritative Caring

 The first theoretical framework that applies to the proposed project is from Katie Eriksson. Katie Eriksson, born November 1943, is a Finnish nursing teacher that currently works as a professor of health sciences at Abo Akedemi University in Vaasa. She is one of the first nursing teachers in the Nordic countries who has been recognized internationally for her concepts and theories. Her concept of a gentle care model includes love/ care/ respect for human holiness and dignity and it emphasizes that the patient’s suffering due to a lack of gentle care is a violation of his/her dignity. The Theory of Caritative Caring consist of five basic concepts: (a) the human being, (b) suffering and health, (c) the caritas motive, (d) caring and (e) caring communion.

The human being (patient, caregiver/family/nurse) – According to Eriksson (1987), the human being is fundamentally an entity of body, soul and spirit. She continues to emphasize that the human being is basically a religious being, but all human beings have not recognized this dimension. The human being is basically “holy”, and the awareness of human self-worth means receiving the human obligation of “serving with love, of existing for the sake of others.” Eriksson stresses that health means a movement of becoming, being, doing, and striving for “integrity and holiness” which is compatible with bearable suffering.

 Suffering and health – In 1998, Eriksson presented the basic category of caring and underline it as “suffering” and that the ultimate purpose of caring is to alleviate suffering. Linked together are suffering and health and if suffering is an inseparable part of human life, then it is regarded as a part of health as well. According to Eriksson, suffering contains different features and attributes which include endurable and unendurable. When suffering is endurable, it is compatible with health and while it is unendurable, suffering immobilizes and prevent the human being from thriving.

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 The caritas motive – the ethics of caring – The definition of caritas which means love and charity is the foundation for all caring. In 2010, Lindstrom, Lindholm and Zetterlund cited Eriksson’s theory (1990) that Caritas is considered the fundamental object of caring science.

In 2003, Eriksson expresses that the act of caring is the innermost sanctified element and re-confirmed the crucial purpose of caritas as the “protection of the individual patient’s dignity.”

 Caring as an expression of Caritas – From Eriksson’s theory, the principle of nursing is considered caritative caring and she further differentiate the two words, namely caring nursing and nursing care. According to Eriksson, caring nursing is a form of caring without discrimination, that emphasizes the patient as a whole, together with woes and wishes. Nursing care, on the other hand, pertains to the nursing care process that implies good care only when it is supported on the deepest core of caring. The basic belief of caring is based on caritas. Caring is something that is “original and natural and can be expressed through tending, playing, sharing, learning, and teaching in a spirit of love, faith and hope.” True caring is reinforced on benevolence and is not acquired from advanced skills and/or technology and that a nurse’s aptitude to express empathy results from the personal experiences with love and suffering. According to Gaut & Boykin (1993), the basic structure of caring is the relationship between two individuals, the patient and the caregiver/nurse, and for the caregiver/nurse to assure the patient feel that he/she is the most important person at that occasion and that they feel secure in that relationship.

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 The caring communion- This concept embraces the framework, the meaning and the approach that defines caring. Eriksson further concluded that since the suffering human being is in need of being invited into a caring culture and compassionate communion in order to experience love, faith, hope and meaning in daily life (Eriksson, 1995, 1996, 1998, 2006, 2013; Lindstrom, Nystrom & Zetterlund, 2014), inviting individuals into such a communion is therefore an “ethical responsibility and core foundation of each act of caring.”

Eriksson’s theory influencing this project. Inspired by her theory of Caritative Caring, I chose to incorporate her concepts into my implementation project as I work with the elderly with dementia. It is vital that caregivers and nurses taking caring of these vulnerable group of elderlies be empathetic, patient and compassionate. In addition, Erkisson’s theory is applied as a guide and as a reminder for us to concentrate on the person as a whole and not just on the disease and the diagnose. It is crucial to focus on the social, psychological, emotional and physical needs of the person living with dementia. Any therapy will have better results when patients feel they are loved, well taking care of and that they are safe. As a tool, I will implement music as an intervention not only to decrease agitation/ anxiety but also to evoke long-term memories, and to increase communication. Furthermore, collaborating with families to help choose the music that they love and familiar with are especially important since it feels more intimate. Integrating the right songs or music will offer numerous benefits which will provide them with a sense of personal identity, recall their most significant life experiences, and once again recognize their beloved family and friends.

Katharine Kolcaba – The Comfort Theory

 The second theorist that I chose to guide me in my project is, Katharine Kolcaba. Kolcaba, born on December 8^th, 1944, in Cleveland, Ohio, is currently an associate professor of nursing at the University of Akron College of Nursing. She specialized in Gerontology, End of Life and Long-Term Care Interventions, Comfort Studies, Instrument Development, Nursing Theory, and Nursing Research. She first developed her comfort theory in 1990 for health practice, education, and research. She described comfort as existing in 3 forms: (a) relief, (b) ease, and (c) transcendence. According to Kolcaba et al. (2006), the comfort theory is defined as the state of relief that occurs when a specific comfort need is met; the state of ease that occurs when the patient is calm or happy; and the state of transcendence that occurs as the patient is functioning at an optimal level.

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Kolcaba’s theory influencing this project. The underlying principles of this theory as stated previously, strongly support the general goal of nursing interventions and can be useful to all practice areas in health care. Kolcaba’s theory, therefore, is also considered for my implementation project for patients with dementia. According to Kolcaba, comfort is “enhanced when the patient perceives that the negative tensions are changed by environmental interventions which result in positive tensions that lead to positive behaviors.”Hence, music intervention in this project, is the recommended positive tension that would stimulate states of ease and relief in order to assist productive behavior and reduce the anxiety and agitation in these individuals.

 With these two theories in mind, I will be implementing my plan of music therapy to the dementia residents at the board and care facility using the PDSA model. Through the residents’ personal choices of songs, music, as an intervention will be applied to put them at ease in addition, it will help to bring back childhood memories and life-long experiences. With a lot of personal touch, care and consideration, the staffs/caregivers will be taught to implement this therapy in the afternoon, after the residents have had their lunch and once they are cleaned, settled and comfortable. The session will last anywhere from thirty minutes to an hour. Each resident will have their own selection of songs provided by the family and music will be played from an MP3 player. Families are encouraged to participate, and the caregivers will be advised to sit with each resident when therapy is in session. While the therapy is taking place, residents’ demeanor and behaviors will be observed, recorded, and documented. We will make note on whether their verbal skills and physical movements have improved after each session. My goal is to do this for several weeks to observe the impact of music on the people with dementia residents and to make any changes as needed to facilitate positive changes not only in their communication skills but also in their emotional, social, psychological, physical and behavioral well-being.

References

• Eriksson, K. (1987). Vardandets ide. Stockholm: Almqvist & Wiksell. The idea of caring. Stockholm: Almqvist & Wiksell.
• Eriksson, D. (1998). Understanding the world of the patient, the suffering human being: The new clinical paradigm form nursing to caring. In C.E. Guzzetta (Ed.), Essential readings in holistic nursing (pp.3-9). Gaitherburg, MD: Aspen.
• Eriksson, K. (2006a) Theory of Caritative Caring. In M. Tomey & R. Alligood (eds.), Nursing Theorists and their work (6^th ed., pp.191-223). MO: Mosby. St. Louis, USA.
• Eriksson, K. (2006b) The Suffering Human Being. Nordic Studies Press, Chicago, USA.
• Gaut, D.A. & Boykin, A. (1993). Caring as Healing: Renewal Through Hope. National League for Nursing Press, New York, NY.
• Lindstrom, U.A., Lindholm, L., and Zetterlund, J.E. (2010). Theorist of Caritative Caring. In Alligood MR and Tomey AM (eds) Nursing theorists and their work. 7^th ed. Missouri, USA: Mosby Elsevier, pp. 191-221.
• Kolcaba, K., Tilton, C, & Drouin, C. (2006). Comfort Theory: A unifying framework to enhance practice environment. Journal of Nursing Administration, 36 (11) 538-544.
• Kolcaba, K. (1994). A Theory of holistic comfort for nursing. Journal of Advanced Nursing,19, 1178-1184.