ANALISA JURNAL

1. Judul penelitian :

Persepsi kelompok terapi musik lansia penghuni panti jompo di Taiwan

2. Tujuan penelitian :

Untuk menguji persepsi terapi musik kelompok di antara penduduk lansia dari sebuah

panti jompo di Taiwan.

3. Metodologi penelitian

a. Variable penelitian :

Variabel yang digunakan dalam penelitian ini adalah:

1. Variabel independen (bebas)

Pada penelitian ini, variabel independennya adalah pengaruh terapi musik.

2. Variabel dependen (terikat)

Variabel dependen dalam penelitian ini adalah kelompok lansia panti jompo di

Taiwan.

b. Hipotesis :

Ha : Terapi musik kelompok dapat memberikan dampak yang positif bagi lansia

yang tinggal di panti jompo.

Terapi musik memberikan stimulasi sensorik dan intelektual yang mengurangi

stres pada orang tua , meningkatkan toleransi rasa sakit mereka , melemaskan

mereka, dan mengalihkan perhatian mereka dari rasa sakitnya. Terapi musik

meningkatkan kualitas tidur lansia ; mengurangi perilaku gelisah , perilaku

agresif , dan depresi pada pasien dengan demensia .

c. Rancangan penelitian

Jenis penelitian :

Penelitian eksperimental (menggunakan desain posttest -only , dengan

masing-masing subjek secara acak yang ditugaskan untuk 1 dari 3

kelompok) .

Pendekatan waktu :

Penelitian ini menggunakan pendekatan kualitatif untuk pengumpulan data

dan termasuk kegiatan musik aktif dan pasif . Metode ini memungkinkan

kita untuk memahami perspektif peserta dan untuk melibatkan mereka

secara lebih aktif dalam terapi musik .

Para peserta lansia menerima terapi musik untuk kelompok 1jam setiap

minggunya selama 3 bulan , itu dilakukan 2 minggu sekali dari Mei 2004

sampai Mei 2005 .

Setiap sesi dibagi lagi menjadi delapan bagian : tahap awal , pemanasan ,

menari , kelompok bermain dengan instrumen perkusi , musik kelompok

bermain , mendengarkan musik santai , mendengarkan pertunjukan musik

oleh pemain tamu , dan tahap akhir .

Pengumpulan data :

Sebelum data dikumpulkan , izin diperoleh dari administrator kepala di

panti jompo karena panti jompo Taiwan tidak memiliki papan review

kelembagaan . Penduduk Lansia sepenuhnya diberitahu tentang studi

sebelum setiap kelompok fokus , meyakinkan kerahasiaan data mereka ,

dan persetujuan lisan mereka diperoleh . Izin diminta untuk rekaman -

rekaman sesi dan mencatat .

Setelah 6 bulan terapi musik , kelompok fokus dilakukan oleh SLC dan

HCL di panti jompo di ruang yang sama yang digunakan untuk terapi

musik kelompok . Kelompok fokus dipandu oleh tiga pertanyaan : ( 1 )

Bisakah anda jelaskan tentang perasaan dan pikiran Anda ketika Anda

menghadiri kegiatan musik grup ini ? ( 2 ) Aspek apa yang paling

berpengaruh untuk anda dari aktivitas musik kelompok ini? ( 3 ) Bagian

apa dari kegiatan musik kelompok ini tidak Anda sukai dan mengapa ?

Secara total , tiga kelompok fokus diadakan , masing-masing dengan enam

sampai delapan peserta yang hadir , dan berlangsung selama sekitar 1jam .

Kelompok fokus diadakan sampai tidak ada informasi baru muncul dari

analisis data ( saturasi data) .

Populasi:

Populasi pada penelitian ini adalah 350 lansia yang berada dirumah jompo

Kota Changhua , Taiwan Tengah .

Sampel dan teknik pengambilan :

Peserta dalam kelompok fokus ( N = 17 ) direkrut secara purposive

sampling dari 350 tempat tidur rumah jompo di Kota Changhua , Taiwan

Tengah . Fasilitas ini adalah untuk orang tua yang menggunakan kursi

roda . Syarat peserta :

1. Usia ≥ 65 tahun

2. Telah berpartisipasi dalam terapi musik kelompok minimal 3 bulan

3. Mencetak ≥ 24 pada Mini - Mental State Exam 40 untuk memastikan

mereka bisa mengungkapkan perasaan dan persepsi mereka tentang

berpartisipasi dalam terapi musik kelompok.

4. Bersedia untuk berpartisipasi dalam sebuah wawancara kelompok

fokus .

Di antara 17 peserta ( 11 perempuan dan 6 laki-laki ) yang berpartisipasi

dalam 3 kelompok fokus , 4 berpartisipasi dalam 2 sesi diskusi kelompok ,

dengan sisanya hanya berpartisipasi dalam 1 sesi . Rata-rata usia peserta

adalah 80,5 tahun ( kisaran = 70-90 tahun ) , dan semua memiliki penyakit

kronis . Sembilan peserta ( 52,9 % ) belum menerima pendidikan formal ,

tetapi mampu berbicara dan memahami bahasa Mandarin. Sisanya 47,1 %

telah menerima pendidikan dasar .

Instrumen penelitian :

Alat yang digunakan dalam penelitian ini :

1. Kelompok bermain dengan instrumen menggunakan alat musik

perkusi ( drum , simbal , atau blok kayu )

2. Kelompok bermain tanpa instrumen(bermain bola , meniup

gelembung , atau bercerita dan mendengarkan musik)

Analisa data :

Transkrip verbatim wawancara direkam dianalisis dengan dua tahap

induktif analysis konten. Pada tahap pertama , transkrip verbatim dari tiga

kelompok fokus secara independen dikodekan oleh SLC dan HCL . Pada

tahap kedua , dua peneliti membandingkan dan mendiskusikan coding

mereka untuk mencapai konsensus tentang coding , sehingga

meningkatkan keandalan analisis. Keandalan analisis lebih ditingkatkan

dengan berbagi temuan penelitian dengan peserta , yang menegaskan

bahwa temuan akurat mencerminkan pengalaman mereka . Akhirnya,

kepercayaan dari data yang dipastikan dengan menggunakan kelompok

fokus, yang biasanya memiliki validitas tinggi karena kredibilitas

komentar peserta.

PERCEPTIONS OF GROUP MUSIC THERAPY AMONG ELDERLY NURSING HOME RESIDENTS IN TAIWAN

Chen, Shu-LingView Profile; Lin, Hui-Chuan; Jane, Sui-Whi. Complementary Therapies in Medicine17.4 (Aug 2009): 190-5.

Abstract (summary)

To explore the perceptions of group music therapy among elderly nursing home residents in Taiwan.

Focus group methodology was used to explore the perceptions of elderly participants about their experience of group music therapy. Verbatim transcripts of audiotaped interviews were analysed by content analysis.

In total, 3 focus groups were held with 17 wheelchair-bound elderly residents. Analysis of participants' perceptions of group music therapy revealed two major themes: (1) strength derived from the group dynamic and (2) enhanced quality of life. The first theme included three subthemes: (1) sense of energy, (2) distraction from suffering, and (3) confirmation as a person. The second major theme included four subthemes: (1) variety added to life, (2) motivation to exercise, (3) learning positive behaviour, and (4) greater life satisfaction.

Elderly, wheelchair-bound residents of a nursing home in Taiwan positively viewed their experiences with our group music therapy programme, particularly its active component. The findings of this study suggest that healthcare providers should consider integrating group music therapy into their programmes for elderly nursing home residents and design the therapy to add variety to their life, give them a sense of autonomy by having them choose their preferred musical activities, and improve their cognitive function.

Full Text

Introduction

Aging populations are a global phenomenon, which is much more pronounced in developed countries. In Taiwan, the population≥65 years old grew from 1,490,804 (7.1%) in 1993 to 2,287,029 people in 2006.1 In the past, Taiwanese adult children cared for their elderly parents, but social and cultural changes have led to a shift in focus from the traditional extended family to the nuclear family.2 In addition, couples have fewer children and more women are entering the labor force, resulting in fewer family caregivers available to provide direct care for elderly family members.2 Furthermore, 70% of Taiwanese elders suffer from one or more chronic illnesses, which are a major cause of disability.3 This increase in the number of chronically ill and disabled elders has increased the demand for institutionalised long-term elder care in Taiwan.4

Elderly persons who are relocated to an institutional living environment may experience distress, social isolation, sadness and profound hopelessness, resulting in an overall decline in physical and psychological functioning.5,6 To improve the physical, psychosocial, cognitive, and spiritual performance of elderly residents, healthcare providers at nursing homes recognise the importance of implementing activities such as music therapy.7-9 Most studies on the therapeutic effects of music therapy have been quantitative,7-16 and only a few have been qualitative.17-19 Among the qualitative studies, only one examined the perspective of elderly nursing home residents,17 but that study was published in Chinese. Since many elderly Chinese people live in the west, it is important for western clinicians to better understand why music therapy works for elders and under what circumstances, thus facilitating implementation of this programme in nursing home facilities. Therefore, the purpose of this qualitative study was to examine the perceptions of group music therapy among elderly residents of a nursing home in Taiwan.

Characteristics and beliefs of elderly nursing home residents

Elderly persons admitted to a nursing home are often characterised by a deterioration in their physical and/or mental health status. They have chronic health problems accompanied by a gradually waning functional ability,20,21 physical disabilities, and lack of family support.22 Institutionalised elders report feelings of being abandoned, of feeling stressed by a lack of personal freedom and privacy, restrictions placed on their movements, and loss of control over many aspects of their life.21,23-25 As a result, many regard residential care homes as the ultimate "dumping place," where they will "idle till death."2626(p605) They often consider their situation as "living in jail."2121(p913) Also, many institutionalised elders tend to isolate themselves due to disease-related deterioration.27

Therapeutic use of music

Since the 1940s, music has been used as a non-pharmacologic intervention to change behaviour, emotions, and physiology28,29 in the areas of pain management, dementia, palliative care, and oncology.12,30 Music therapy has two main branches: active and passive therapy.10,31 Active music therapy requires that participants play musical instruments or sing along with the therapist. In passive music therapy, participants listen to live or recorded music.10,31 Music provides sensory and intellectual stimulation that reduces stress in the elderly, increases their pain tolerance, relaxes them, and distracts them from their pain.7,32 Music therapy improves older adults' sleep quality33 ; decreases agitated behaviour,8,9,34 aggressive behaviour,35 and depression13 in patients with dementia.

Methods

Design

An exploratory qualitative design was used to gain a deeper understanding of the perceptions of elderly nursing home residents regarding their experience of group music therapy. Focus group methodology was chosen because it permits nurse clinicians to explore a specific phenomenon in small groups of older adults 36 and to capture their dynamic interactions when they share commonality.37 Focus

groups also encourage a dynamic exchange among the participants, enabling them to react and build on the response of others.38,39

Sample and setting

Participants in the focus groups (N =17) were recruited by purposive sampling from a 350-bed nursing home in Changhua City, central Taiwan. The facility was for elders confined to a wheelchair. Eligible participants were (1) ≥age 65 years, (2) had participated in group music therapy at least 3 months, (3) scored ≥24 on the Mini-Mental State Exam 40 to ensure they could express their feelings and perceptions about participating in group music therapy, and (4) were willing to participate in a focus group interview.

Among the 17 participants (11 females and 6 males) who participated in 3 focus groups, 4 participated in 2 focus group sessions, with the remainder participating only in one. The participants' mean age was 80.5 years (range=70-90 years), and all had chronic illnesses. Nine participants (52.9%) had not received any formal education, but were able to speak and understand Mandarin. The remaining 47.1% had received primary education.

Group music therapy

The elderly participants received group music therapy for 1h each week for 3 months, then once every 2 weeks from May 2004 to May 2005. The group music therapy was adapted from previously described procedures,10,11 and included both active and passive musical activities. Each session was subdivided into eight sections: initial phase, warm up, dancing, group play with percussion instruments, musical group play, listening to relaxing music, listening to a musical performance by a guest performer, and the concluding phase. For the initial phase, the facilitator (second author, HCL) greeted each participant by name and welcomed them to the activity. During the warm up, the participants massaged each other's hands or were assisted by volunteers. The elderly then moved their upper bodies in time to the music, which varied gradually from a slow to a fast rhythm. While they "danced," they shook small bells and clicked castanets. Then the group played with percussion instruments (e.g., drums, cymbals, or wood blocks), followed by group-play without instruments (e.g., playing ball, blowing bubbles, or story telling), and listened to relaxing music. In the final activity, participants listened to an invited guest sing or play an instrument. In the concluding phase, HLC expressed her appreciation to the participants and shook hands with each one. After the music activities, HCL also showed her respect for participants by asking about their feelings, asking what songs they would prefer next time, or suggesting that they hum a song if they did not know the words.

Data collection

Before data were collected, permission was obtained from the head administrator at the nursing home since Taiwanese nursing homes do not have institutional review boards. Elderly residents were fully informed about the study before each focus group, assured of the confidentiality of their data, and their oral consent was obtained. Permission was requested to tape-record the session and take notes.

After 6 months of music therapy, focus groups were conducted by SLC and HCL at the nursing home in the same room used for the group music therapy. The focus groups were guided by three questions: (1) Can you please tell me about your feelings and thoughts when you attended this group music activity? (2) Which aspect of the group music activity influenced you the most? (3) What part of this group music activity did you like best and why?

In total, three focus groups were held, each with six to eight participants attending, and lasting for about 1h. Focus groups were held until no new information emerged from the data analysis (data saturation).38

Data analysis

Verbatim transcripts of the audiotaped interviews were analysed by two stages of inductive content analysis.41 In the first stage, verbatim transcripts of the three focus groups were independently coded by SLC and HCL. In the second stage, the two researchers compared and discussed their coding to reach consensus on coding, thus enhancing dependability of the analysis. The dependability of the analysis was further enhanced by sharing the research findings with participants, who confirmed that the findings accurately reflected their experiences. 42 Finally, the trustworthiness of the data was ensured by using focus groups, which typically have high face validity due to the credibility of participants' comments.39,43

Results

Analysis of participants' comments about their experiences of group music therapy revealed two major themes: strength derived from the group dynamic, and enhanced quality of life. These major themes and subthemes are described in detail below.

Strength derived from the group dynamic

This major theme refers to the positive aspects of engaging in group musical activities. The music therapy programme evoked a group dynamic that energised elders, helped distract them from their psychological distress and physical discomfort, and confirmed their self-worth.

Sense of energy

During music therapy, the participants met residents from different units and participating nursing students. When involved in playing instruments together, the participants felt a sense of energy from the group dynamic, making them feel stronger and more alive. As one participant (A) said, "This group music activity makes me want to move because the group has a powerful effect." Similarly, participant (J) said, "After I attended the group music activity, I felt happy and energetic, especially with so many other people of my age group, as well as volunteers and nursing students joining in the activity." Another participant (P) commented, "Because there were many other elderly people that joined in this activity, I felt alive rather than sit around drowsing all day long."

Distraction from suffering

While attending the group music programme, elderly residents gradually forgot their pains and discomforts, instead focusing on the music activity. For example, one participant (E) said, "Before this activity, I just waited for my 3 meals each day. I suffered in my mind about not being able to go home. When attending this group, I concentrate on the activities and I forget how distressed I feel." Another participant (H) related, "I have had Parkinson's disease for a very long time, and I get tired from the tremors, they are very distressing. However, after attending this activity, I feel calm, I forget the pain in my teeth, and I forget to be annoyed with my tremors."

Confirmation as a person

The participants felt taken seriously when greeted by name and welcomed to the activity. They felt respected as individuals. One participant (I) explained, "At the beginning of the activity, you [researcher] greeted me and shook my hand after the activity. That made me feel respected and a very important member."

This sense of being respected as a person and an individual gave them the feeling that participating in the group music activity increased their autonomy. They often felt a lack of personal control in the nursing home, but when they attended the music activity, they could choose their preferred percussion instrument and sing old, familiar songs. For example, one participant (C) said, "When I joined this activity, I could choose the drum and play it at full force, it felt so great." Similarly, another participant (G) said, "I felt such freedom to shake the tambourine and to sing aloud in this group music activity."

Some of the participants asked for more information about group music therapy and the music. For example, one participant (O) said, "I would like to know more about the history or background of each song, because it would expand our knowledge."

Enhanced quality of life

This major theme describes the elderly nursing home residents' perception that participating in the group music activities positively impacted their quality of life in several ways. The programme added variety to their lifestyle, motivated them to exercise, taught them positive behaviours, and enhanced their life satisfaction.

Variety added to lifestyle

The residents often felt that the nursing home lifestyle was rigid, with an inflexible schedule for meals, bedtime, and rising. When they joined the group music therapy, they at least experienced some variety in their life. As one participant (D) said, "The lifestyle in this nursing home is so routine ...eating, watching TV, and sleeping all day long. Every day is so boring. When I joined this activity, my life became more interesting." Similarly, another participant (N) said, "Before this activity, during the daytime, no one would talk to us or arrange any activity for us. I had no freedom to act on my own in this nursing home and I could only sit on the bed unless someone helped me into my wheelchair. My daily life is

extremely boring and totally meaningless. The only thing I can do is waiting for each meal every day. Since attending this group, my life has changed and I look forward to it all week."

The elderly participants felt involved, they enjoyed the group music therapy, and it left them with the memory of the musical rhythm, which afterwards stimulated them to exercise in the nursing home. For example, participant (L) said, "Before, I waited for meal times and bed time each day. Now when I get up in the morning, I have music in my heart and begin to exercise by myself [taps his right hand with the left hand]."

Motivation to exercise

The participants perceived that their physical function had improved since participating in the music activity. One participant (A) said, "I have more strength in my hands and feet than before. Now, I don't depend on the bed handrail, and I can get up quickly from bed [shows how he gets up quickly]. I am quite happy to learn many skills and I feel motivated to exercise."

Most participants expressed that since attending the music therapy, they actively used skills they had learned to compensate for their impaired health. For example, participant (M) said, "Through this activity, I learned how to massage myself and tap my body to avoid deteriorating health." Likewise, another participant (B) said, "Sometimes, even when you [the researcher] didn't come, I still had a musical rhythm in my heart and I exercised by myself [demonstrates by lifting his paralyzed left hand with his right hand]."

Learning positive behaviour

The majority of participants felt that the group music activities helped them to control their emotions better. For example, participant (G) said, "By watching and listening to others in this activity, I learned how to help and care for others [in the nursing home], and I'm more open-minded." Another participant (K) observed, "I feel that some of the people have better habits since they joined this activity. They follow group regulations and don't grab the TV remote controller." Similarly, participant (Q) said, "Before the music therapy activity, we had little respect for each other. We always argued with each other. After attending these music activities, we are more prepared to wait for each other and show more respect to each other."

Greater life satisfaction

Participants felt that their suffering was somewhat eased and derived more satisfaction from life. Their mood changed from negative (e.g., death wishes) to more positive, and they felt encouraged to face their future.

For example, participant (F) said,

"In the beginning I often wanted to die, because I did not want to be a burden to my family. But, when I attended the group music activity I wanted to live my life as good as I could, and exercise my body and take care of myself. Thus, I changed my mind and decide to persevere with my life."

Another participant (O) said,

"I was afraid of my deteriorating health. My bones used to ache and I did not know what to do about it, and when I got up in the morning, both my hands and feet were so cold. But now, after joining this activity, I know how to make my body warm, and the music activities make me feel cheerful and relaxed, and now I have more confidence to face the future and live."

Discussion

This study found that 6 months after elderly residents of a nursing home in Taiwan participated in a programme of group music therapy, they perceived that they derived strength from the group dynamic and their quality of life was enhanced. The findings suggest that such a programme could be used in residential care homes to counter the beliefs of elders that these homes are the ultimate "dumping place" where they "idle till death." 26

The elderly participants perceived that these music activities improved their physical function and made it easier for them to look after their own health. This finding is consistent with Guzzetta's assertion29 that music therapy encourages clients to become active participants in their own health care. The move to a nursing home is often accompanied by major changes in an elderly person's health.5,6 The elderly participants described their mood as having changed from mostly depressed to happy and cheerful. These findings are similar to those of other studies conducted in Taiwan using music therapy to improve activity and psychological status of elderly nursing home residents. 15-17 Unlike those studies, however, our study used a qualitative approach to data collection and included both active and passive music activities. These methods allowed us to understand participants' perspectives and to engage them more actively in the music therapy.

Through group music therapy, the elderly participants were gradually distracted from their suffering. This finding is similar to a previous report7 that older people with osteoarthitis pain who listened to music had reduced stress levels and increased pain tolerance, simply by being distracted from their pain. In addition, 10 of the 17 elderly residents in our study perceived improvements in their depression, anxiety, and agitated behaviour. This finding is consistent with previous reports that music therapy decreased stress and irritable behaviour in the elderly. 9,44

The elderly participants were also able to draw strength from the group dynamic. The synergistic effects of the music and seeing other wheelchair-bound elders moving their upper limbs to the music and acting cheerfully motivated everybody in the room. This dynamic helped them to learn positive behaviours. Moreover, the participants greatly increased their interactions with other residents. This finding is consistent with a previous report that dynamic music therapy promotes socialization. 10 Thus, music therapy can be used to improve the physical, mental, and social functions of elderly nursing home residents.

In addition, the participants confirmed that they felt truly respected and confirmed as individuals when the researcher greeted them and shook their hands. This finding is consistent with a previous finding that older adults were more satisfied with providers who treated them as individuals. 45 Our study

participants enjoyed the autonomy of choosing their own instruments and playing the instruments as forcefully as they wanted. This aspect may have released some of the negative emotions they possibly harboured for having to live in a nursing home. This idea is consistent with the proposition that music and movement will help the elderly become aware of their bodies, release any negative energy, and help them achieve a proper body-mind balance. 29

Our study also found that the participants experienced more satisfaction from life, which enhanced their quality of life. This finding has not been mentioned in previous studies.8-11,34,44 The reactions of the elderly in our study may be due to the qualitative approach and active form of music therapy we chose (dynamic music activity for an entire year). Participants in our study learned/refined musical skills and were encouraged to move their bodies in time to the music, which made exercising less burdensome and improved both their health and their overall mood. Since the participants were not only older residents of a nursing home, but were also confined to wheelchairs by illness, providing physical activity and variety to their life was a challenge. This activity and variety were provided by our group music programme, thus enhancing their quality of life. Therefore, our study results offer a unique way to enhance quality of life for this population.

Conclusion

Our findings illustrate that elderly wheelchair-bound residents of a nursing home in Taiwan positively perceived their experience of our group music therapy, particularly the active component of the programme. The positive experiences of this programme brought them increased joy and improved both their perceived health and quality of life. Our findings suggest that healthcare providers should consider integrating group music therapy into the routine of life in nursing homes. The findings of this study also add to the body of knowledge about the positive effects of music therapy in both gerontological nursing education and in clinical practice.

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AuthorAffiliation

Shu-Ling Chen, Hui-Chuan Lin. Department of Nursing, Hung Kuang University, Taiwan; Corresponding author. Tel.: +886 4 26318652x3005; fax: +886 4 26331198.

Sui-Whi Jane. Department of Nursing, Chang Gung Institute of Technology, Taiwan

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