Stress Reduction with Staff Working in a Geriatric Setting:

A Qualitative/Quantitative Study

…there is nothing either good or bad but thinking makes it so

Hamlet, Act 2, Scene 2

Shakespeare stated:

“Physical, mental, or emotional strain or tension.”

“a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize”• (Vrijkotte et al., 2000).

What is Stress?

Judith Pinkerton article “Music Wellness Programs: Merging Self-Responsible Strategies”, Mar. 3, 2012-cellular biologist Dr. Bruce Lipton reports that over 95% of all disease-related ailments in this country are created by stress. -18.8 million American adults suffer from depressive disorders.-40 million Americans who suffer from exaggerated worry and tension are 6x more likely to be hospitalized than those who are not similarly afflicted.-Estimated medical costs associated with treating stress, depression, and anxiety exceed $300 BILLION annually!

Stress Costs!

Numerous articles about stress and effect on our bodies•Fight or flight•Adrenaline •Cortisol•Blood Pressure•Bodies then adapt to chemicals.

Stress:

If stress continues over long periods of time• Telomeres• Slows down bodies rate of repair• Premature aging• Associated with heart disease, osteoporosis

• Suppresses immune system• Slows down the metabolism• Robs the body of vital nutrientsYou may have:• Headaches• Aches and pains• Dizziness• Heartburn• Muscle tension• Insomnia• Fatigue

Stress Cont.

Chronic Stress can lead an individual to experience:• Anxiety• Fear• Fatigue• Restlessness• Depression• Insecurity• Lack of Motivation• Impaired memory or concentration• Excessive smoking, drinking and eating

Effects of Stress on Emotions

What emotions do you feel with each song?• Sad• Happy• Lonely• Inspired• Angry• Scared• Excited• Frustrated

Music Experiential

To investigate the stages of stress found in staff members of the geriatric setting, and decrease that current stress level, as well as increase staff cohesion and socialization by using client preferred songs played at some point in the day, with interaction between staff participationAll wings participatedAccompaniment:• Mostly live music on the guitar• Some recorded music played on laptop with speakers

Purpose of this Study

-Hey Soul Sister

-Battle Hymn of New Orleans

-Everybody Everybody Wants to Love

-Sugar Sugar

-500 Miles

-You Are My Sunshine

Experiential

Smith and Morris (1977), reported that background music had an effect on level of worry and emotionality and demonstrated music may have great effects on level of relaxation and stress reduction.Pelletier (2004), stated “in regards to the [my] study, results showed a 95% decrease in stress…This is a large effect size and strong enough indication that music combined with relaxation techniques does have a significant impact on decreasing arousal due to stress.”

Research

Physical stimulationRelaxation through deep breathingAnxiety ReductionPositive impact on emotional and affective levelsIncreases positive affect while decreasing negative affectIncreases sIgA levelsStrengthens voluntary and involuntary muscle movements in the glottal region

Physical Processes of Singing

Staff on all wings participated in the song of the day, excluding night shift staff. Staff varied in age and job description throughout the entire building

Only 30 staff members surveys were collected and used for the study out of 231 staff members

Staff were randomly selected from each wing

Participants

The pre and post survey’s were administered through the Director of Nursing as anonymous questionnaire sheets and the subjects were not told it was for music therapy, rather just a form to turn in as a consensus for overall staff well being.

The questionnaire used in the surveys was comprised of two parts; Part I involved a ten and five point Likert type scale, and Part II was open-ended. Some of the questions on Part I were taken from “The Music Therapist’s Handbook” (Hanser, 1987).

Data Collection

MT sessions were held at each wing in the morning between 8a.m and 8:45a.m at Sunshine Terrace Monday through Friday for a period of 15 weeks

• Songs were client preferred, gathered by a request form handed out prior to the first session

•MTI’s specified songs needed to be upbeat and happy songs while also being appropriate for them to be able to play for the day

Procedures

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Pre and Post Survey: Positive Behaviors to Increase

Pre SurveyPost Survey

Results

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Pre and Post Survey: Negative Behaviors to Decrease

Pre SurveyPost Survey

Results Cont.

•The results indicate that with the addition of music therapy in a therapeutic treatment regime, levels of stress, and other behaviors linked to stress, will decrease while levels of work enjoyment and feelings of work appreciation will increase

Results

Frequent comments made on part 2 (open ended section) of the survey included:“I LOVE the morning songs that the music therapy girls provide for us. It makes it a lot more enjoyable to come in and be positive and is a great way to start my day,” “Camaraderie with some employees thanks to the music!” “Music in the mornings starts all our wings staff day out positive,” “I feel more a part of a group thanks to the music in the mornings bringing all the staff together to get to know each other and sing with each other”“I feel like we’re being appreciated more now and the song of the day helps staff get to know each other better so it’s more fun to work with each other!”

Discussion

Article about “happy, upbeat music”•Article showed that individuals who listened to 50 minutes of happy upbeat music had an increase in SigA levels=increased immune function.

Study to determine if individuals in a fast paced work environment such, as a SNF, after listening to 20 minutes of “happy, upbeat music” would have a decrease in number of sick days as compared to last year.

Purpose of Study

Individuals were given a questionnaire at the beginning of study.• Self report number of guess-timated sick days• Self report number of days individual came to work sick

Song of the Day20 Minutes of random “happy, upbeat music”•Client preferred music• Boom boxes switched with wall mounted CD players

Method

Study ran 18 weeks•4-6 weeks in- made more CD’s•Requested by staff

Post study survey filled out by staff

Method Cont.

Last year 75% of survey responders said that level of stress at work contributed to feeling sickThis year 33% of survey responders said that level of stress at work contributed to feeling sick

Stress at Work

Last Year This Year0

2

4

6

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Called inCame In

Graph

Client Preferred MusicTried to include a wide range of

genresCannot enforce listening to music

Staff constantly in motion to assist residentsStaff rotation through the wingsStudies implemented at the same timeStaff tired of survey’s

Confounding Factors

1. Start at the top!2. Show administrators the research3. Offer a pilot program4. Take the time to research your clientele- (your

employees)5. Use the RIGHT music6. Educate your staff7. Invite participation at the front line- include EVERYONE!8. Do a Pre and Post- SHOW YOUR WORK!9. Expand your pilot study with support from administrators

(i.e. new equipment, time in schedule, etc.)10.HAVE FUN!

How to make it happen:

“Music exalts each joy, allays each grief, expels diseases,

softens every pain, subdues the rage of poison and of plague.”

John Armstrong, 1744

Cass, H. & Holford, P. (2000). Natural Highs: Supplements, Nutrition, and Mind/Body Techniques to Help You Feel Good. Penguin Group, New York.DeVito, P. (1996). The Immune System vs. Stress. USA Today Magazine, 132(2590), 50-56.Kuhn, D. (2002). The Effects of Active and Passive Participation in Musical Activity on the Immune System as Measured by Salivary Immunoglobulin(SigA). Journal of Music Therapy, 39(1), 30-39.www.foodmatters.tv (2011). Healing Music.Bolger, N.D., Kessler, A., Schilling, R.C., & Elizabeth, A. (1989). Effects of daily stress on negative mood. Journal of Personality and Social Psychology, 57(5), 808-818.Cavanagh, M. E.(1988, July). What you don’t know about stress. Personnel Journal, pp. 53-59.Cohen-Mansfield, J.(1989). Sources of satisfaction and stress in nursing home caregivers: Preliminary results. Journal of Advanced Nursing, 14, 383-388.

Bibliography

Cowan, D.S.(2001). Meeting whose needs? The personal needs of the therapist. Special feature information sharing. Davis, W. B. & Thaut, M.H.(1989). The influence of preferred relaxing music on measures of state anxiety, relaxation, and physiological responses. Journal of Music Therapy, 26(4), 168-187.Hanser, S.B. (1987). Music therapist’s handbook. St. Louis: Warren H. Green, Inc.Jaffe, D.T. & Scott, C.D.(1984). From burnout to balance. New York: McGraw-Hill Book Company. McEwen, B.S. (2008). Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. European Journal of Pharmacology, 583(2), 174-185.

Bibliography cont.

McEwen, B.S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338, 171-179.Pelletier, L.C.(2004). The effect of music on decreasing arousal due to stress: A meta-analysis. Journal of Music Therapy, 41(3), 192-214.Pinkerton, J. (2012). Music Wellness Programs: Merging Self-Responsible Strategies. March 3, 2012.Sapolsky, R.M. (2004). Why zebras don’t get ulcers: The acclaimed guide to stress-related diseases, and coping (3rd edition). New York, NY: Holt Paperback and Company, LLC.Smith, C.A., & Morris, L.W. (1977). Differential effects of stimulative and sedative music on anxiety, concentration, and performance. Pyschological Reports, 41, 1047-1053.Vrijkotte, G.M., Van Doornen, L.J.,& De Geus, E.J. (2000). Effects of work stress on ambulatory blood pressure, heart rate, and heart variability. American Heart Association, 35, 880-886.Walworth, D.(2003). The effect of preferred music genre selection versus preferred song selection on experimentally induced anxiety levels. Journal of Music Therapy, 40, 2-14.

Bibliography cont.