A survey of clinical practice in music therapy. Part II: Clinical practice, educational, and clinical training

Part II of the clinical practice survey is concerned with the amount and quality of equipment available to music therapists, length of activity sessions, accountability procedures, patient or client referral sources, scheduling procedures, communication with other professionals, and the status of music therapy in institutions. Additional data include ratings of music therapy education and clinical training experiences, the master's degree in music therapy, and opinions concerning NAMT registration for music educators working in special education.     

Songs composed for use in music therapy: a survey of original songwriting practices of music therapists

While researchers have documented the efficacy of clinical songwriting in music therapy, limited research has been conducted on songs composed by music therapists that address clinical goals. The purpose of this research was to examine the original songwriting practices of music therapists. Professional music therapists (N = 1,364) received a 14-question survey via email asking each to identify client populations and clinical goals addressed by original songs, their length of time in clinical practice, and specifics about their acquisition of songwriting skills. The data collected from 302 completed surveys revealed that respondents who used original songs were most likely to work with children and adolescents in schools or the developmental disability field and wrote songs in order to individualize treatment. Music therapists working with persons over 65 years of age in long term care or assisted living programs were the least likely to use original songs in clinical practice, opting for interventions utilizing the client's familiar music. Most music therapists found songwriting generally easy, but only 37% indicated that they acquired this skill during their undergraduate degree. Additional research on the clinical efficacy of original songs and therapist's compositional processes is needed to identify best practices models for strategic songwriting.     

Collaboration and consultation: a survey of board certified music therapists

The purpose of this study was to examine the consultation and collaboration practices of board certified music therapists (MT-BC) in order to establish a baseline of service provision for this profession. Board certified music therapists who are members of the American Music Therapy Association (n = 2039) were asked to complete a survey regarding collaboration and consultation in their professional practice. Specific areas of investigation included (a) population(s) with whom the MT-BC works and site of service delivery, (b) selfidentification as a collaborator and/or a consultant (c) populations with whom the MT-BC collaborates, and (d) frequency, methods, purpose, locations, and personnel for whom they provide consultative services. Responses (n = 873, 42.8%) from each of the 8 regions designated by the American Music Therapy Association (AMTA) indicated a significantly higher report of collaboration versus consultation among music therapists. Implications for music therapy education and need for further research are discussed.     

Group work in occupational therapy: a survey of practice

This paper documents the extent to which occupational therapists use groups in practice. A questionnaire was mailed to 300 occupational therapists nationwide. Questions included the types of groups occupational therapists lead, the facilities in which the groups take place, the patients included, the activities presented, and individual and groups goals. Results were tabulated based on the responses of 120 therapists. We established that 60% of occupational therapists in all areas of practice lead groups in treatment. Of the 209 groups described by the respondents, there was a significantly greater number of activity groups than verbal groups. Also, there were significantly more groups with ten or less members than groups of more than ten. This paper describes the ten categories of groups that were identified in this study.     

School-based practice patterns: a survey of occupational therapists in Colorado.

OBJECTIVE: This purpose of this study was to describe school-based occupational therapy practice for kindergarten through twelfth-grade students in Colorado and to examine occupational therapy practice in light of current education policy and published views of best practice. METHOD: Study data were provided by 105 occupational therapists and occupational therapy assistants who completed a 24-item questionnaire. RESULTS: Occupational therapists carried an average caseload of 43.68 students; most frequently served kindergarten through third-grade students with perceptual or communicative disabilities; and delivered services most often in pullout treatment areas. Practitioners spent most of their work week providing direct services. Remedial or developmental approaches were used 62% of the time and compensatory and educational approaches 37% of the time. Individualized education program goals addressed by occupational therapists were most frequently developed by the occupational therapist and targeted students' sensory or motor impairments. Workshops on autism and sensorimotor intervention techniques were reported as the primary and preferred forms of professional development. CONCLUSION: The strong majority of reported occupational therapy services contrasted with emerging views of best practice. They were, however, consistent with the Colorado Department of Education's guidelines for "motor specialists" that address occupational therapy, physical therapy, and adaptive physical educators working in schools. Study findings are discussed.     

Acupuncture practice in the UK. Part 1: Report of a survey

The article is the first of two that discuss a study of acupuncture practice in the UK. It summarizes the findings of a national postal survey of acupuncture practitioners undertaken in 1995. The survey aimed to provide a broad overview of both where and how acupuncture was practised. The respondents included doctors, physiotherapists and non-medically qualified acupuncturists. The findings highlight both the diversity of practice between different professional groups as well as the areas where there appears to be some convergence.     

The work of nurses in Australian general practice: A national survey

Background

Following recent reforms to Australia's health system, nurses now comprise a significant and growing sector of the Australian primary care workforce, but there is little data describing the services they provide.

Objectives

This study aimed to describe the patient consultations of nurses in Australian general practice, including patient characteristics, reasons for the consultation, treatments provided and other actions taken.

Design

The study was a national cross-sectional survey, with each participating nurse collecting information about 50 nurse-patient encounters.

Setting

General practice settings in all regions of Australia.

Participants

108 nurses volunteered in response to advertisements and 104 returned completed study materials. Participants included Registered (Division 1) and Enrolled (Division 2) nurses working in a general practice setting.

Methods

Data were collected between May 2007 and May 2008 using a profile questionnaire and a series of encounter forms. Information was gathered on reasons for encounter, patient characteristics, and actions taken. Data were classified using the International Classification of Primary Care.

Results

The final data set included 5,253 nurse-patient encounters. 37.2% of patients (95% CI 33.3-41.2) were aged 65 and over, and 57.1% were female (95% CI 54.9-59.5). The majority of encounters (90.7%) were with existing patients of the practice (95% CI 89.1-92.7). The most common reasons for encounter were general and unspecified problems (35.4 per 100 encounters; 95% CI 31.8-39.1), followed by skin-related problems (20.0; 95% CI 17.3-22.8), and cardiovascular problems (11.0; 95% CI 8.7-13.3). Common management actions included medical examinations (20.7 per 100 encounters), immunisations (22.5), diagnostic tests (10.6), and dressings (15.8). Approximately 30% of encounters involved advice-giving.

Conclusions

The findings confirm the generalist nature of the General Practice Nurse role, with a wide range of patient types and clinical conditions. There is a clear influence of current funding and organisational arrangements on work patterns, with tasks that have specific funding (including immunisations and wound care) featuring prominently in nurses’ work. Whilst nurses’ rates for presenting conditions were similar to doctors at a general level, specific actions taken and problems managed differed. New policy reforms in Australia are supporting greater flexibility in the General Practice Nurse role, maximising efficient use of nurses’ skills in the primary health care context.     

Research in music therapy: a survey of music therapists' attitudes and knowledge

To examine attitudes toward and knowledge of research in music therapy, a three-part survey was administered to 150 randomly selected music therapists, with complete surveys returned by 66 respondents. The survey consisted of a cover page gathering background information, a series of 20 statements assessing attitudes toward music therapy research, and 25 true-false questions examining subjects' knowledge of research terminology and methodology. Analysis of survey responses indicated a generally positive attitude toward research, but dissatisfaction with the current status of research in the field. No relationship was found between research attitudes and research knowledge, and no significant effects on research knowledge were discerned for education, present position, or research background. Results of this study are discussed in terms of implications and issues to be addressed by academicians, clinicians, and researchers in music therapy.     

A descriptive study of private practice in music therapy

Of professional music therapists in the American Music Therapy Association, 9% report being self-employed or in private practice. The purpose of this paper was to provide initial data concerning music therapists who are in private practice. The researchers successfully sent out 353 surveys and 118 were completed and returned via electronic mail for a response rate of 33.4%. Although general, results indicate that music therapists in private practice are active within the profession, doing presentations and inservices, conducting research, supervising practica students and interns, and keeping current with forthcoming research. Data indicate that most music therapists chose private practice due to a more flexible schedule, increased salary, and the lack of previously established job opportunities. Additionally, 65.8% of respondents reported having a bachelor's degree in music therapy, 29.2% reported having a master's degree, and 5.1 % reported having a doctoral degree. Quantitative results, rationale, and suggestions are included in an attempt to assist music therapists who are interested in starting private practices.     

Making a difference to practice: clinical benchmarking. Part 1

In the first of two articles, the authors describe how an internal clinical practice benchmarking group was established in Preston to compare and share examples of best practice. The aim was to ensure consistent high standards of care practice across the trust. Activity related to discharge planning and visiting is used here to illustrate the effectiveness of clinical practice benchmarking as a continuous quality improvement tool. The second article will appear in Nursing Standard on May 3.     

Statement: occupational therapy services in work practice.

Occupational therapy practitioners focus on the individual's ability to participate in productive occupations throughout their life span. Through prevention, assessment, and intervention strategies, occupational therapy practitioners often collaborate with other members of the health care team and assist persons to optimize their ability to engage in purposeful occupation while facilitating a safe and successful entry into or return to work.     

New agents in gastrointestinal malignancies: Part 1: Irinotecan in clinical practice.

In 1996 two chemotherapy agents were introduced by the U.S. Food and Drug Administration (FDA) with indications for the gastrointestinal malignancies for advanced colon and pancreatic cancers. The agents approved were irinotecan hydrochloride (CAMPTOSAR Injection, Pharmacia & Upjohn Company, Kalamazoo, MI; also investigated under the name CPT-11) for the second-line treatment of metastatic colorectal cancer, recurrent or relapsed, after 5-fluorouracil (5-FU)-based therapy, and gemcitabine hydrochloride (GEMZAR for injection, Eli Lilly and Company, Indianapolis, IN; also referred to as dFdC) for first-line treatment of locally advanced and metastatic cancer of the pancreas. Irinotecan and gemcitabine, with demonstrated activity in colorectal and pancreatic cancer, respectively, are generally well tolerated and can be administered safely on an outpatient basis. Clinically relevant activity is documented for both single agents. Therapy-related side effects are manageable with appropriate monitoring and intervention, and reversible with dose modification or discontinuation. This article is one of a two-part series on new chemotherapeutic agents for gastrointestinal malignancies. The first in the series, this article addresses the agent irinotecan hydrochloride (CAMPTOSAR Injection). The second article, appearing in a subsequent issue, will review gemcitabine hydrochloride (Gemzar for Injection). Both articles review the current clinical use, safety profile, and key patient management guidelines for these new and novel cytotoxics. As clinical and investigational use of irinotecan and gemcitabine increases, the oncology nurse and other members of the health care team will need to anticipate potential treatment associated toxicities and be knowledgeable in their early identification and management. As patient advocates, oncology nurses play a key role in treatment outcome and related quality of life through expert patient education, symptom recognition, and intervention individualized to patient tolerance. This first article of the series addresses irinotecan, which in 1996 was approved for the second-line therapy of metastatic colorectal cancer, recurrent or elapsed, after 5-fluorouracil (5-FU).     

The relations between personality characteristics, work environment, and the professional well-being of music therapists

The purpose of this correlational study was to investigate the relations between professional well-being (as characterized by positive attitudes toward work and longevity as a practicing music therapist) and the following factors: age, level of education, income, attitudes regarding the workplace (e.g., perceived control, feeling valued, as well as the amount of perceived comfort and input into administrative policies), attitudes toward work as measured by the Maslach Burnout Inventory (Maslach & Jackson, 1986a), and measures of stress and stress management as measured by the Stress Profile (Nowack, 1999a). Participants included 49 music therapists who had between one to 36 years of work experience. Correlations indicated that those respondents with greatest professional longevity tended to have higher ratings on items regarding cognitive coping strategies (e.g., positive appraisal and threat minimization) and greater perception of personal achievement. These correlational results are related to psychological theories regarding occupational burnout and cognitive hardiness.     

Implications of technology in music therapy practice and research for music therapy education: a review of literature

This article reviews the use of technology in music therapy practice and research for the purpose of providing music therapy educators and clinicians with specific and accurate accounts of the types and benefits of technology being used in various settings. Additionally, this knowledge will help universities comply with National Association of Schools of Music requirements and help to standardize the education and training of music therapists in this rapidly changing area. Information was gathered through a literature review of music therapy and related professional journals and a wide variety of books and personal communications. More data were gathered in a survey requesting information on current use of technology in education and practice. This solicitation was sent to all American Music Therapy Association approved universities and clinical training directors. Technology applications in music therapy are organized according to the following categories: (a) adapted musical instruments, (b) recording technology, (c) electric/electronic musical instruments, (d) computer applications, (e) medical technology, (f) assistive technology for the disabled, and (g) technology-based music/sound healing practices. The literature reviewed covers 177 books and articles from a span of almost 40 years. Recommendations are made for incorporating technology into music therapy course work and for review and revision of AMTA competencies. The need for an all-encompassing clinical survey of the use of technology in current music therapy practice is also identified.     

A survey of trainees' opinions and current clinical practice after behaviour therapy training

The widespread use of cognitive behaviour therapy principles in psychiatric/mental settings has been an ongoing feature of health and social care since at least the 1960s. The current study evaluated the training process as well as the use of the skills by course participants on a dedicated behaviour therapy course in Ireland. A cross sectional study was undertaken, using postal distribution of a questionnaire based on a similar study undertaken in the UK. The sample comprised all graduates of the course from 1986 to 1999 (N = 257). Thirty-three per cent of respondents report using their behaviour therapy skills to a high level since completion of the course. Approximately 53% of respondents reported having changed job since completion of the course. Significant differences emerged within this group in relation to their ratings of the importance of various elements of the course and also in relation to the perceived enhancement of both general clinical skills (P = 0.000) and specific behaviour therapy skills (P = 0.000) as well as the rating of current skills (P = 0.015) and the respondents' use of behaviour therapy since completing the course (P = 0.015). While a high proportion of participants had some prior theoretical or experiential exposure to behaviour therapy, the findings report high satisfaction levels with the training they received. However, the survey signals deficits in terms of the usage of the skills. While on the one hand, the general and specific skills acquired while on the course seem to transfer quite easily across functions and levels of responsibility, it is of concern that over a 13-year period, only 17% of respondents indicated that behaviour therapy was the main focus of their work. The implications of these findings are discussed in relation to policy and practice issues.