St Paul's Hospital -
Palliative Care Unit (PCU)

Vancouver , BC

ADOPTED BY 
DAVID AND JONATHAN BARNETT
AND FAMILIES

[Music Therapist] Josh adds significant therapeutic value to the care that we provide here on the Palliative care unit. Patients comment on his ability to decrease their anxiety and improve their mood. Patients look forward to his sessions and often remark on his ability to transport them to another place and time in their lives. He is incredibly skilled and intuitive. Through his music Josh makes connections with patients and their families that are meaningful and last their entire stay on our palliative care unit.”

Gillian Jarvie, RN. BScN.

Clinical Nurse Leader

The palliative care music therapy program at St. Paul’s Hospital currently offers 18.75 hours of weekly sessions. As most patients in the palliative care unit (PCU) are not mobile or are in too much pain to move, most music therapy sessions are conducted on an individual basis at the bedside in shared, semi-private and private rooms. Sometimes, impromptu group sessions are possible in the multi-bed rooms.

The focus of palliative music therapy services include:

• Comfort care: helping to reduce the perception of pain, improving ability to rest or sleep and calming breathing

• Life Review / legacy work to create something with a patient they can leave behind for a loved one

In 2020, with the support of Music Heals Foundation, the program has been able to connect with over 100 patients directly and held over 200 music therapy sessions.

Demographic

Patients served by the music therapy program are in-patients in the St. Paul’s Hospital Palliative Care Unit (PCU) and who have been clinically diagnosed as being at end-of-life. The patients include all genders and come from all walks of life and diverse cultural backgrounds. They range in age from early 20’s to 100, with most patients being in their 70’s.

How does Music Therapy uniquely address the needs of clients at in the Palliative Care Unit?

Hearing is widely thought to be the last sense to go in the dying process and research has shown that some people may still be able to hear while in an unresponsive state at the end of their life.

In palliative care, music can help to ease pain, regulate breathing and soothe anxiety by allowing patients to focus on something outside of their physical discomfort, and possibly, even feel the vibrations of the sound through their bodies which can be very healing.

Music is something that can uniquely connect with and comfort people when consciousness appears gone, when someone has lost the ability to speak, when pain is too great. The comfort it provides to family and friends as well, either directly (sitting at bedside) or indirectly (the knowledge their loved one is receiving music therapy) is quite unique to our program.

How has COVID-19 impacted the program?

With the exception of a couple of short pauses for staff testing, the palliative music therapy program has continued uninterrupted throughout the pandemic. Due to the nature of the facility, patients and classification of staff as essential health workers, the music therapy program has been able to continue in-person service while adapting to strict infection prevention and control measures including health and temperature checks at entry, donning personal protective equipment such as scrubs, masks and eye protection, and being vigilant about hand hygiene at all times.

As the pandemic puts strain on the health care system right across Canada, it’s the staff on the frontlines within our hospitals and care homes who have risen to the challenge. It has been a stressful and anxious time for everyone including patients and staff. During this time, the main form the music therapist’s sessions has taken is receptive music therapy, with an emphasis on patient, and even at times, staff choice.

With day passes suspended and no patient visitors allowed (except for compassionate reasons on PCU) for most of the past several months, it has been especially challenging for our patients who are now more isolated and anxious with less to keep them occupied. Comments the music therapist has heard from patients during this time include “thank you so much for coming, you’re all we have to look forward to”, as well as the more frequent “wow I feel so much better now”. The fellow staff also share their gratitude, as this has been as much uncharted territory for them as it has been for anyone else.

At times, when the hospital’s census was low as the hospital prepared for the potential influx of COVID patients, there was an unusual and eerie hush on units and a tension in the air. To address this, the music therapist would set up near the nursing station and play. The music filtering through the whole unit would cut through that tension, putting smiles on those around to hear it.

Things are slowly transitioning to a new normal at St. Paul’s Hospital and in the Palliative Care Unit. The music therapy groups can be slightly bigger (still with physical distancing), they can hand out instruments as long as they are extremely diligent about sanitizing, and there is more optimism than dread filling the units.

Since the onset of the pandemic, many new procedures have had to be implemented within our St. Paul’s Hospital palliative care music therapy program in order to minimize infection risks and ensure the safety of those they serve. These include reducing the size of music therapy groups, thoroughly sanitizing instruments and equipment between every use, adoption of rigorous PPE and hand hygiene routines as well as more frequent meetings to update on hospital COVID-19 surge preparations and updates.

All this takes more time and as a result St Paul’s would like to increase the number of hours a week that they offer the palliative music therapy program in order to sustain the number of patients and music therapy sessions they are currently able to provide.

Funding would allow them to add 9 hours of music therapy a week. Combined with other philanthropic contributions which also support the program, this will increase the palliative music therapy program from the current 18.75 hours to 21 hours a week.

The additional hours will also serve more sessions for patients, who with existing hospital visitor restrictions and closure of patient lounges and social spaces, are more isolated, anxious and have less to keep them occupied.

By Music Therapist Josh Denny-Keys:

“I first met Barry Duggan at the end of July, when I had received a referral from the care team on our unit. Barry was admitted for symptom management (pain), due to headaches and falls caused by glioblastoma (brain cancer). After a few moments of meeting me and learning what I do, I was dubbed “the troubadour”, and he was eager for our first session. We began talking about music and I asked what he liked. To my amusement he threw the question back at me and said “whatever you want to play”. I made some suggestions, and The Beatles seemed to stick.

After one song, Barry was already touched. He couldn’t believe he was having live music played to him at his bedside and said “hearing the songs come out of you makes it come alive”. In his own words, he went from “lying in bed feeling sick to feeling joyous and fun, like I’m at a concert!”.

Barry shared that his favourite music was lesser known rock groups from 1965-1970, introducing me to bands such as The Peanut Butter Conspiracy and The Chocolate Watchband. In our next session I played one of the songs from The Peanut Butter Conspiracy on a Bose Speaker from YouTube, and he was amazed saying how grateful he was to have been able to hear it.

One day he wanted to “send a message” to a neighbour in his shared room, requesting a song that had their name in the title. Afterwards he said: ““Requesting a song for a neighbour, sending that message, and knowing [they] heard it and enjoyed it really elevated the mood and connected us”.

Joshua Denny-Keys

Joshua Denny-Keys is an Accredited Music Therapist who has been part of the Providence Health Care Palliative Care Team since March 2017 and the Dr. Peter Centre since November 2017. Throughout his career, Josh has worked with many diverse populations including acute mental health, long-term care, acute palliative care and HIV/AIDS care. Josh believes in patient-directed care and in meeting those he works with where they are at coming in. He then builds goals and the therapeutic relationship from there.

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