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Striking the Right Chord: How one nurse used music to reach dementia patients

Posted: Oct. 12, 2015

Image that shows the hospital setting, dementia patients, musical instruments and the chord

It was the Christmas season, and Marty Land, MSN, RN, was working in an Alzheimer’s dementia ward in the Veterans Affair hospital in Kerrville, Texas. One of the patients was what they called a “wanderer” — someone living with Alzheimer’s who leaves a pre-defined boundary. He wasn’t the only one; this particular VA had a 15-bed wanderers lock-down unit in addition to a 20-room 45-bed unit of individual rooms and three- to four-bed wards of bed-bound patients.

But this gentleman was different, and not just because of the red felt fedora he always wore. He was difficult to handle and often roamed into other patients’ rooms, keeping them from resting. When this occurred, as it often did, he would be put in a tabletop restraint in his darkened room, where he would yell and pound on his table until someone on staff would go in and give him an injection of Haldol, which he always fought. He would eventually settle down, but would be groggy and unsteady on his feet most of the rest of the afternoon.

“I could see that this was not a very good way to handle the problem and fortunately I had an idea,” Marty said. “I started singing to him.”

Marty Land in School of Nursing
graduation regalia, August 1995

Marty’s journey to her job in the VA was, as the song goes: a long and winding one. As a girl growing up in Arlington and Fredericksburg, Texas, she longed to teach music in public school. She enrolled in Texas Lutheran University in Seguin, Texas, but was told by counselors that an aptitude test she had taken showed she had higher scores in health care than in the music area. Marty persevered, however, and graduated with an undergraduate degree in music education.

Jobs were scarce, and after marrying and having her first child, she developed an interest in maternal/child nursing, much to her surprise, and became a licensed vocational nurse. Twelve years and another child later, she decided to go back to university for more nursing education. She chose the University of Texas at Austin School of Nursing because of a new program they offered designed for people holding baccalaureate or graduate degrees in disciplines other than nursing who are interested in pursuing both a registered nurse license and master of science in nursing degree.

Under the tutelage of Dr. Judith Jellison, one of the pioneers in music therapy, Marty used her elective credits to learn more about how music could be used with great success to help individuals of any age and suffering from many illnesses and conditions. For children, music and rhythm can become a behavioral tool as well as an expressive tool. With seniors, it offered a way to reach back into the memory that those with dementia could no longer access. It was the ability to help seniors that would come in handy that December night in the Kerrville VA.

“Because it was Christmas, I began singing carols,” Marty said. “To my surprise, he quickly joined me in a beautiful baritone voice, remembering virtually all the words to all the songs. He closed his eyes and we sang for about 15 to 20 minutes. I watched as he sang himself to sleep without the aid of either the tabletop or the Haldol. It was wonderful to see it work! I will not delude myself with thinking that this technique will always work, but it was certainly worth the try.”

Marty continued to use music therapy with patients at the VA as well as later when she worked with a doctor who treated worker’s compensation patients using stress management and reduction techniques. The regimen included a variety of strategies, such as massage and muscle stimulation, as well as music therapy. And as helpful as it can be at times, she understands that music therapy is just one tool and one that not everyone will feel comfortable using.

“Music is a wonderful, if underutilized, tool for nurses. Sometimes as nurses, we get used to handling problems only one way and forget that sometimes a different approach will obtain a different outcome,” she said. “I know that it may be difficult to allow staff 20 minutes solely with one patient, but it’s worth it if only to avoid having to use physical or chemical restraints.

“It’s easy for nurses to get wrapped up in their duties when often what a patient needs most is their attention. I think we fail to realize how important it is to spend a little extra time treating our patients or clients as people and get to know them. That’s so helpful in determining which options are best suited to each individual.”

Marty is retired now, as much as the mother of two and grandmother of six can be. And what about the red fedora-wearing gentleman? Marty reported that he awoke after a 45-minute nap without being in a stupor. He was in a good mood, smiling and happy — a much different result than after the physical and chemical restraints.

“Instead of doing the same routine thing, I mixed it up and was able to help my red fedora gentleman get the first nap he had had in years, and it was much less stressful on the staff and the other patients,” she said. “The clock seems to move faster than we can get our work done, but taking 20 minutes to try something different resulted in the knowledge that music — at least in this instance — was a good alternative tool.”

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