1 Introduction

The intensive care unit (ICU) is defined as an organisation of healthcare professionals providing multidisciplinary care in a specific area of the hospital, caring for patients who require respiratory support together with support for at least two organs or systems, as well as all complex patients requiring support due to multi-organ failure [1]. One of the main consequences of the ICU environment and the stressors experienced during the stay is the well-documented Post Intensive Care Stress Syndrome (PICS). Patients treated in the ICU or with prolonged ward stays may have sequelae that require specialised rehabilitation. A considerable proportion of these patients also require initial transfer to a neurorehabilitation centre within the hospital setting to recover from moderate to severe sequelae. This involves specific therapies in the fields of physiotherapy, occupational therapy, speech therapy and neuropsychology [2]. Over the past 15 years, studies of cognitive, physical and mental function among survivors of critical illness have indicated that a significant proportion of these patients suffer from new or worsening impairments and disabilities. This has led to the concept of PICS being proposed [3].

The role of nursing professionals in relation to the care of the person and family members is of great importance. They maintain direct and constant contact with them, which allows them to help them to calm down and/or alleviate feelings such as stress, anxiety, uncertainty and anguish [4]. Nurses in an adult ICU have a pivotal role in the diagnosis, intervention and pursuit of solutions to stress factors. This is in accordance with the objective of providing humane and comprehensive care, which facilitates the establishment of emotional bonds and minimises unpleasant feelings in hospitalised individuals and their families [5].

In Spain, the “HUCI Project” is the “Manual of Good Practices of Humanisation in Intensive Care Units,” which is based on seven strategic lines for its development in the ICU [6]. Strategic line number seven for the humanisation of care, entitled “Humanised infrastructure”, incorporates complementary therapies into the healthcare system. The prevailing focus of conventional medicine on treating and supporting potentially reversible conditions with the objective of survival can frequently result in the dehumanisation of the ICU [7]. The integration of complementary therapies into conventional medical practice can enhance the patient experience. It is evident that music- and animal-assisted interventions have the potential to enhance the psychophysiological condition of patients, thereby offering a more human-centred approach [7].

The potential psychological benefits of physical rehabilitation in the ICU have been considered due to the well-documented link between physical and mental health. These psychological benefits are greater when a ‘humanised’ or person-centred approach is adopted. This is consistent with the findings of the study by Laerkner et al. [8], which described that ICU patients found ‘hope through mobilisation’ [8]. It can be reasonably assumed that anxiety is a common occurrence in patients who are experiencing neurocritical illness, as well as in their primary caregivers.

As the number of patients surviving intensive care increases, mental health problems have become a subject of growing interest for researchers. Among these, post-traumatic stress disorder can have a significant impact on the quality of life of intensive care survivors. A study by Righy et al. [9] of cognitive, physical and mental function among critically ill patients found that a significant proportion of these patients suffered from new or worsening impairments and disabilities, which gave rise to the previously discussed concept (SPCI) [9].

It can be posited that music therapy, as defined by Wigram et al. [10], is designed to facilitate the development of an individual's potential and/or restoration of impaired functions, thereby enabling them to achieve both intra- and interpersonal integration and, as a consequence, a superior quality of life. This can be achieved through the implementation of prevention, rehabilitation or treatment strategies [10].

Music therapy is a therapeutic approach that uses music to promote overall health and well-being. It may involve composing, singing, movement, listening or relaxation techniques. Recognised as a form of complementary medicine, it helps alleviate pain, anxiety, depression and stress related to illnesses such as cancer and its treatment [11]. In his 1997 book, “Defining Music Therapy”, Bruscia, an authority on the use of music as therapy, posits that music therapy is “transdisciplinary”. This implies that it is not confined to a single isolated discipline with clear and immutable boundaries; instead, it is a dynamic combination of multiple disciplines encompassing two main areas: music and therapy. The convergence of music-related disciplines with therapy-related disciplines results in the formation of a hybrid discipline known as music therapy [12].

Finally, the team led by Greenberg et al. [13] emphasises the significance of oxytocin and neurocircuits related to reward, stress and the immune system. The study demonstrated that the social brain networks associated with music production, as opposed to those involved in music listening, are analogous to networks associated with social processes in human cognition, such as mentalisation, empathy and synchrony. Moreover, these components have evolved to foster social affiliation and connectivity [13].

2 Justification for the Study

The present research is motivated by the necessity to explore and comprehend the subjective experiences of critically ill patients participating in music therapy sessions. In a hospital setting, particularly in Critical Care Units (CCUs), the primary focus is on the clinical management of acute conditions. However, there is an increasing recognition of the benefits of non-pharmacological interventions [14, 15], such as music therapy, on the emotional, psychological and physical well-being of patients.

While numerous studies have demonstrated the positive effects of music therapy, such as the reduction of stress [16], depression [17] and pain, there is limited evidence available that explores patients' personal experiences and perceptions of its influence on the disease process and their recovery [18]. This is particularly salient in the context of critical care, wherein patients frequently encounter circumstances of heightened vulnerability, uncertainty and distress.

The present study adopts a descriptive qualitative design, enabling a qualitative approach to capture the lived experiences of patients and offering a rich and detailed perspective on their perception of the music intervention. Comprehension of these experiences enhances knowledge regarding the perceived impact of music therapy and also furnishes valuable information to personalise and optimise interventions in critical contexts.

Furthermore, the integration of music therapy as part of integrated care strategies in CCUs may be furthered, supporting its inclusion in evidence-based guidelines and protocols. The ultimate objective is to furnish healthcare professionals with supplementary instruments to address the biopsychosocial needs of critically ill patients, enhancing not only their physical recovery but also their quality of life during hospitalisation.

Consequently, this research not only addresses a gap in knowledge, but also has practical and ethical implications for humanised care in the critical care setting.

3 Aim of the Study

The aim of this study is 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 and subsequent recovery.

4 Design and Methods

This study adopted a descriptive qualitative design to explore participants' experiences in a straightforward and context-sensitive manner. Qualitative descriptive research produces data that captures the “who, what and where” of experiences or events from the participants' subjective viewpoint. This design is particularly suitable when direct information is needed from those who have experienced the phenomenon under study [19].

Music therapy was implemented by a professional known as a music therapist. In our context, a professional known as a music therapist holds a degree in Musicology, followed by a specialised master's degree in music therapy. This academic and professional training provides the necessary competencies to apply music-based interventions in clinical settings.

The music therapy intervention was designed to be personalised and patient-centred. Before the session, the therapist consulted with family members or caregivers to determine the patient's musical preferences, ensuring that the selected music would be meaningful and emotionally resonant for the individual. Sessions lasted an average of 20 min and were conducted simultaneously with invasive medical procedures, such as oral mucosal lavage, endotracheal tube extubation or central venous catheter management. During these sessions, the selection of songs was based on a comprehensive and individualised process. The music therapist engaged in discussions with family members, caregivers and, when possible, the patients themselves to gather information about their musical preferences, personal history and cultural background. Additionally, implicit reactions to different musical stimuli were observed by the music therapist during the sessions to further refine the selection. The goal was to ensure that the chosen music resonated with the patient on both an emotional and physiological level. This process allowed for the use of familiar and personally meaningful music to enhance engagement and therapeutic outcomes.

The music therapy sessions were conducted live, with the music therapist playing live instruments next to the patient, allowing for real-time adaptation to each patient's needs and clinical situation. Personalised music was used, tailored to the individual characteristics of each patient. The intervention included the use of voice and musical instruments such as guitar and percussion. Additionally, the volume of the music was carefully adjusted according to the patient's breathing patterns and clinical condition to ensure a supportive and therapeutic environment.

The music used in the sessions cannot be generalised, as it was personalised according to each patient's preferences and clinical condition. The tempo, rhythmic structure, form, dynamics and lyrical content were adapted in real-time to align with the therapeutic goals and the patient's physiological and emotional state. This individualised approach ensured that the music was either stimulating or sedating, depending on the needs of each patient.

4.3 Data Analysis

This study employed Braun and Clarke's reflective thematic analysis, a method of qualitative data analysis that involves identifying recurring patterns in a data set in order to recognise, analyse and report on themes. The approach is comprised of several stages: familiarisation with the data, coding, generation of themes, review of themes, definition and naming of themes and writing up [21]. The objective of this approach is to identify patterns and themes within the data set and subsequently interpret them in order to gain a deeper understanding of the phenomenon under investigation [22] (Table 2).

TABLE 2. Phases for the thematic analysis of Braun and Clarke [22].

5 Ethical and Research Approvals

6 Results

In order to understand the results of this study, 14 semi-structured interviews were conducted. The socio-demographic data of the participants are explained in Table 3.

The following topics concern the experience of patients admitted to the Intensive Care Unit in relation to the music therapy session they received. The patients' experience is a consequence of the humanisation of care and the accompanying and proximate presence during the session. The patients described their perceptions of music therapy as a positive experience, a form of distraction and accompaniment during their illness. Furthermore, the patients indicate that music therapy facilitates closer relationships with their relatives and healthcare staff.

Patients report that participation in music therapy can alter their mood, whether they are experiencing a period of sadness or a more positive emotional state. This leads the patients to express that their experience during the sessions has been pleasant and enjoyable.

The music therapy sessions they received in the ICU helped them to distract themselves from the situation they were going through, focusing on the music they were listening to. This allowed them to meditate and have a moment of disconnection and introspection with themselves.

From the analysis of the content extracted from the face-to-face interviews, 3 themes emerged that represent the bulk of the experiences and emotions of the 14 study participants after the music therapy sessions. The main findings are described below, organised according to each theme:

6.1 Humanising Care Through Interdisciplinary Approaches in Critical Care

This theme refers to the beneficial and unusual aspect of music therapy in the ICU, which is described as an unforgettable event that has the effect of making the unit more humanised and closer to the patients and their families. Patients suggest that the music therapy sessions should be extended in duration to allow for a more comprehensive experience and indicate that this therapy could be generalised throughout the hospital due to its significant contribution to the patients and their families. It was posited by the patients participating in the study that the provision of piped music should be considered as an intervention within the context of ICU services. The rationale for this suggestion is that music therapy has the potential to produce pleasant sensations and experiences (Figure 1)

I wasn't thinking about anything or anyone, I was just focused on me and the song they were singing to me, I was listening to the guitar and I was getting more and more relaxed. (PAT3)

Furthermore, music therapy engenders the perception that the healthcare team is composed of benevolent individuals, which can enhance confidence and reassurance. Similarly, this therapy engages ICU patients who find themselves in unexpected situations. Music therapy generates both a pleasant feeling in them and an improvement in their ability to adapt to coping with their illness.

I think music therapy can have a huge influence on the comfort of being here, it gives you more joy. You think that the people there are working, and you are more alone, so it brings a feeling of warmth and that you are not alone. The music therapist played the song that touches my heart, I felt more accompanied, less sad. (PAT13)

The participant discusses the potential of music therapy as a form of distraction for patients during their hospitalisation and throughout their illness process in the ICU. Furthermore, the patients report that these sessions serve as a way of accompanying them in their lives and bringing them closer to their families and the healthcare staff who attend them. This helps to establish a therapeutic relationship with the healthcare professionals and is identified as a way of bonding with their families.

I was thinking about the sounds of music, what was coming through my ear was music, I was listening to music, thinking about music and I wasn't thinking about anything else, that is, I wasn't thinking about my wife, only about what I was listening to. (PAT4)

This section explores the positive impact of music therapy in the ICU, highlighting its role in humanising care and offering emotional comfort to patients and families. Patients suggested extending the session duration and expanding the hospital-wide therapy due to its therapeutic value. Music therapy fosters feelings of well-being, connection with healthcare staff and improved coping during critical illness.

7 Discussion

8 Limitations

It should be noted that this study is subject to a number of limitations.

Communication difficulties during the interviews, particularly with those who were using oxygen masks, presented a challenge. However, this was mitigated by adjusting the audio settings.

The absence of prior qualitative studies on adult ICU music therapy limits the ability to make meaningful comparisons, as the majority of research in this field focuses on paediatric ICUs.

9 Implications and Recommendations for Practice

10 Conclusions

Music therapy emerged as a unique and beneficial intervention, contributing significantly to the humanisation of the ICU environment. Patients perceived the music therapy sessions as memorable events that created a sense of closeness and connection with their families and healthcare staff. The sessions were not only seen as a therapeutic distraction but also as a means of fostering emotional bonds between patients, their loved ones and the healthcare team. Participants expressed that the music made them feel less isolated and more comforted, helping to improve their emotional state and overall sense of well-being. The experience was described as uplifting, creating a warm atmosphere that alleviated feelings of sadness and loneliness. These findings highlight the need to individualise the moment, ensuring that each session aligns with the patient's emotional and clinical needs, maximising its therapeutic impact.

The findings indicate that music therapy played a crucial role in helping patients relax and manage the distress associated with their illness. Patients reported that the sessions allowed them to disconnect from their environment and focus on the soothing effects of the music, which helped alleviate physical discomfort and reduce emotional distress. Music therapy provided a mental escape, enabling patients to temporarily shift their attention away from their illness, which contributed to an overall improvement in their psycho-emotional state.

Music therapy was recognised as an effective coping mechanism that supported both emotional and physical recovery. Patients reported that the sessions helped them recall positive memories, which provided a sense of escape from their current critical situation. The emotional upliftment and relaxation induced by music therapy seemed to foster resilience and fortitude, enabling patients to better manage their illness and recovery process. Several patients expressed that music gave them the strength to face their health challenges with renewed optimism, further highlighting its role as a motivational tool in recovery.

Ethics Statement

The Consolidated Criteria for Reporting Qualitative Research (COREQ) in Appendix 1 has been used [23]. The study was approved by the Ethics Committee of the European University of Madrid (EC 23.238). The study was formally endorsed on 25th April 2023. The authors confirm that they have adhered to the protocols of their institution regarding the publication of participants' data. The right to privacy and informed consent have been respected throughout the course of this study.

Consent

The authors have obtained informed consent from the patients and/or subjects mentioned in the article, and this document is in the possession of the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.