Musicoterapia en Unidades de Cuidados Críticosexperiencia de paciente, familia equipo de salud

Abstract

Introduction. The Intensive Care Unit (ICU) emerges as a challenging clinical environment, where the severity of health conditions and the intensity of therapeutic interventions can generate significant emotional impact on patients, families and healthcare professionals. Music, with its universal power to evoke emotions and its unique ability to communicate across language barriers, has attracted increasing interest as a therapeutic tool in this context. In this sense, music therapy is presented as an innovative intervention that seeks to alleviate stress, promote emotional expression and improve the quality of life of those who are immersed in the delicate environment of the ICU. This thesis explores the impact and efficacy of music therapy in the ICU, analysing how this practice can contribute not only to conventional health care, but also to the humanisation of the hospital experience in critical situations. Objectives. Main objective: To explore the experiences of patients admitted to the Intensive Care Unit, their relatives and the healthcare professionals responsible for their care regarding an intervention with music therapy during an invasive technique or procedure. Specific objectives: PATIENTS: 1. To find out what the patient's experience is like during a music therapy session and their perception of its influence on their disease process. 2. To explore the influence of a music therapy session on the process of recovery from their illness. 3. To explore the influence, from the patients' perspective, of music therapy during the performance of an invasive/painful technique on ICU patients. 4. To find out the mood of the patients after the music therapy sessions. 5. To explore the patients' perception of comfort after the music therapy session during their admission to the ICU. RELATIVES: 1. To explore the degree of satisfaction of the relatives with the experience after the music therapy sessions. 2. To find out the state of mind of the relatives after the music therapy sessions. HEALTHCARE PROFESSIONALS: 1. To explore the previous ideas about the use of music therapy of health professionals applied in their work environment. 2. To explore the perception of healthcare professionals in relation to the effects of music therapy on patients admitted to the ICU after a music therapy session. Method. Design: This study used a qualitative phenomenological method. A qualified music therapist conducted a 20-minute music therapy session with the patient, an accompanying family member and a health professional responsible for the patient's care. Data were collected through semi-structured interviews with the three groups of participants: patients, relatives and health professionals. Participants: Inclusion criteria for patients: Patients aged between 18 and 75 years who wish to participate in the study, who are oriented in person, time and space, Patients who can maintain oral communication. Exclusion criteria for patients: Patients with underlying psychiatric pathology and sedated patients. Inclusion criteria for relatives: Present during the entire music therapy session. Inclusion criteria for professionals: Present during the music therapy session and multidisciplinary team responsible for the patient who wish to participate voluntarily in the study. Sampling strategy: The sampling strategy chosen was theoretical, purposive sampling and snow ball of all participants meeting the inclusion criteria. Data collection: 42 unstructured in-depth interviews were carried out. The interviews were all conducted at the Rey Juan Carlos Hospital in Mostoles. Data collection was terminated due to redundancy of information; when the inclusion of new participants did not provide more relevant information. Purposive sampling was used based on the relevance of the research question. Forty-three participants, women and men, patients, relatives and healthcare professionals working in the Critical Care Unit of the Rey Juan Carlos Hospital of Mostoles, Madrid, were included. The interviews were audio- recorded, transcribed verbatim and a thematic analysis was carried out from the perspective of hermeneutic phenomenology. Analysis: The qualitative analysis used was that proposed by Braun and Clarke. Following the interviews, all audio material was transcribed. These transcripts were then analysed through a coding process involving six stages: 1) familiarisation with the information, 2) inductive coding, 3) identification, review and definition of themes, 4) two coding cycles were applied, 5) axial, focused and selective coding, 6) writing up of results. Quality criteria: COREQ recommendations for the development of qualitative studies were followed. Ethical considerations: The present thesis obtained permission from the Ethics Committee of the European University of Madrid and the permission from the Ethics Committee of the Rey Juan Carlos Hospital of Mostoles. Results. Forty-two participants were included. 14 patients (7 women and 7 men) and mean age 73 years; 14 relatives (7 women and 7 men) and mean age 60 years; and 14 health professionals (10 women and 4 men) and mean age 24 years. The main themes identified describing the experience of using music therapy in the ICU were as follows: 1) Pleasant experiences of patients with music therapy sessions: The theme explores the experience of patients in the Intensive Care Unit with music therapy, highlighting its relationship with the humanisation of care and close support. Patients consider it a positive and distracting experience during the illness, strengthening the connection with relatives and healthcare staff. 2) Patients' experiences of music therapy during invasive techniques and procedures: In this theme, patients highlight that music therapy provides them with an escape during healthcare interventions, evoking pleasant moments from their past. Furthermore, it is examined how this therapy attenuates the fearful environment of the ICU, counteracting the effects of intrusive noises, and how it can alleviate pain and unpleasant sensations during invasive procedures. 3) Family members' pleasant experiences with music therapy sessions: This topic deals with the experiences that family members of patients who are admitted to an Intensive Care Unit have had while participating in a music therapy session. 4) Music therapy as a paradigm and humanistic intervention: This theme talks about how relatives see music therapy as a way of humanising such a special unit as the ICU. The humanistic approach in therapy focuses on understanding the subjective and unique experience of the individual, and the importance of authenticity, empathy and the therapeutic relationship for the healing process. 5) Pleasant experiences of healthcare professionals with music therapy sessions: In this theme, healthcare professionals share experiences in music therapy sessions in the ICU, highlighting its ability to promote relaxation in patients, relatives and themselves, offering comfort and mutual support. They underline that this therapy contributes to the management of anxiety during admission, positively impacting on general well-being. 6) Experiences of healthcare professionals with music therapy. Inclusion of music therapy in the ICU: New paradigms including music therapy in the ICU: This theme explores how music therapy is perceived among healthcare professionals as a potential resource to combat burnout, a condition associated with chronic work- related stress. 7) Experiences of the patient-family-healthcare professional triad regarding music therapy: This theme addresses the perceptions of patients, families and healthcare professionals in a study on music therapy. They highlight music therapy as a positive and distracting experience, noting how it strengthens the connection between the parties and its impact on the therapeutic relationship. Conclusions. The conclusions of this doctoral thesis on the use of music therapy in the Intensive Care Unit (ICU) reveal a significant positive impact on the participants of the sessions; patients, relatives and healthcare professionals. The results indicate that music therapy not only contributes to improving the emotional well-being of patients in such a critical environment as the ICU, but also generates notable therapeutic benefits for their relatives, providing a space for emotional connection and support during difficult times. Furthermore, the positive influence on healthcare staff is highlighted, showing a reduction in stress and fatigue, which may contribute to a healthier hospital environment. These findings support the integration of music therapy as an effective complementary intervention in intensive care settings, promoting the humanisation of healthcare and improving the quality of life of those affected by critical situations.