Musici ontwikkelen steeds vaker projecten voor de gezondheidszorg. In dit artikel analyseert Karolien Dons hoe ze precies vorm geven aan deze participatieve muziekpraktijken. Ze verkent daarbij de nieuwe rollen die musici innemen en hun manieren om daadwerkelijk tot co-creatie te komen met patiënten en zorgmedewerkers.
Since 2015, the research group Lifelong Learning in Music of Hanze University of Applied Sciences Groningen, together with the University Medical Center Groningen (UMCG), has developed and researched the MiMiC practice for patients and nurses on surgical wards. The musicians make tailor-made music in the patients' rooms in collaboration with patients and nurses. They do this on the basis of verbal and non-verbal contact with patients and nurses. Person-centred music-making turns out to be easy to realise in a medical setting and to be meaningful for all involved. People who have just had surgery experience less pain. Nurses feel more deeply involved with their patients. Musicians show sensitivity for the social context in which they carry out their artistic practice.In this project the research group is developing an innovative artistic practice with a focus on elderly patients. Musicians work with patients and the care staff that are taking care of these patients during their stay in hospital. The research should lead to insights in the effects of this practice and to a new training for master students and professional musicians who want wish to specialise themselves in this field. Pilots on six different wards of the UMCG with professional musicians and master students are part of the research which will last two years in its entirety. The project has been granted funding from the 'Banning de Jong Fonds' of the national 'Prins Bernhard Cultuurfonds' and the 'Fonds Sluyterman van Loo'.
In leaving the more traditional territories of the concert performance for broader societal contexts, professional musicians increasingly devise music in closer collaboration with their audience rather than present it on a stage. Although the interest for such forms of devising co-creative musicking within the (elderly) health care sector is growing, the work can be considered relatively new. In terms of research, multiple studies have sought to understand the impact of such work on musicians and participants, however little is known about what underpins the musicians’ actions in these settings. With this study, I sought to address this gap by investigating professional musicians’ emerging practices when devising co-creative musicking with elderly people. Three broad concepts were used as a theoretical background to the study: Theory of Practice, co-creative musicking, and Praxialism. Firstly, I used Theory of Practice to help understand the nature of emerging practices in a wider context of change in the field of music and habitus of musicians and participants. Theory of Practice enabled me to consider a practice as “a routinized type of behaviour which consists of several elements, interconnected to one another: forms of bodily activities, forms of mental activities, ‘things’ and their use, a background knowledge in the form of understanding, know-how, states of emotion, and motivational knowledge” (Reckwitz, 2002, p. 249). Secondly, I drew the knowledge from co-creative musicking, which is a concept I gathered from two existing concepts: co-creation and musicking. Musicking (Small, 1998), which considers music as something we do (including any mode of engagement with music), provided a holistic and inclusive way of looking at participation in music-making. The co-creation paradigm encompasses a view on enterprise that consists of bringing together parties to jointly create an outcome that is meaningful to all (Prahalad & Ramaswamy, 2004; Ramaswamy & Ozcan, 2014). The concept served as a lens to specify the jointness of the musicking and challenge issues of power in the engagement of participants in the creative-productive process. Thirdly, Praxialism considers musicking as an activity that encompasses “musical doers, musical doing, something done and contexts in which the former take place” (Elliott, 1995). Praxialism sets out a vision on music that goes beyond the musical work and includes the meanings and values of those involved (Silverman, Davis & Elliott, 2014). The concept allowed me to examine the work and emerging relationships as a result of devising co-creative musicking from an ethical perspective. Given the subject’s relative newness and rather unexplored status, I examined existing work empirically through an ethnographic approach (Hammersley & Atkinson, 2007). Four cases were selected where data was gathered through episodic interviewing (Flick, 2009) and participant observation. Elements of a constructivist Grounded Theory (Charmaz, 2014) were used for performing an abductive analysis. The analysis included initial coding, focused coding, the use of sensitizing concepts (Blumer 1969 in Hammersley, 2013) and memoing. I wrote a thick description (Geertz, 1973) for each case portraying the work from my personal experience. The descriptions are included in the dissertation as one separate chapter and foreshadow the exposition of the analysis in a next chapter. In-depth study of the creative-productive processes of the cases showed the involvement of multiple co-creative elements, such as a dialogical interaction between musicians and audience. However, participants’ contributions were often adopted implicitly, through the musicians interpreting behaviour and situations. This created a particular power dynamic and challenges as to what extent the negotiation can be considered co-creative. The implicitness of ‘making use’ of another person’s behaviour with the other not (always) being aware of this also triggered an ethical perspective, especially because some of the cases involved participants that were vulnerable. The imbalance in power made me examine the relationship that emerges between musicians and participants. As a result of a closer contact in the co-creative negotiation, I witnessed a contact of a highly personal, sometimes intimate, nature. I recognized elements of two types of connections. One type could be called ‘humanistic’, as a friendship in which there is reciprocal care and interest for the other. The other could be seen as ‘functional’, which means that the relationship is used as a resource for providing input for the creative musicking process. From this angle, I have compared the relationship with that of a relationship of an artist with a muse. After having examined the co-creative and relational sides of the interaction in the four cases, I tuned in to the musicians’ contribution to these processes and relationships. I discovered that their devising in practice consisted of a continuous double balancing act on two axes: one axis considers the other and oneself as its two ends. Another axis concerns the preparedness and unpredictability at its ends. Situated at the intersection of the two axes are the musicians’ intentionality, which is fed by their intentions, values and ethics. The implicitness of the co-creation, the two-sided relationship, the potential vulnerability of participants, and the musicians’ freedom in navigating and negotiation, together, make the devising of co-creative musicking with elderly people an activity that involves ethical challenges that are centred around a tension between prioritizing doing good for the other, associated with a eudaimonic intention, and prioritizing values of the musical art form, resembling a musicianist intention. The results therefore call for a musicianship that involves acting reflectively from an ethical perspective. Doctoral study by Karolien Dons
Het onderzoek Meaningful Music in Health Care (MiMiC) biedt kansen voor interprofessionele samenwerking van musici en verpleegkundigen. Daarnaast blijkt MiMiC ook tot een versterkt contact tussen patiënten en verpleegkundigen te leiden en tot een toename van compassie van verpleegkundigen. Wat houdt deze interprofessionaliteit precies in en hoe kan deze worden verder vorm krijgen?In Professional Excellence in Meaningful Music in Healthcare (ProMiMiC), beoogt een internationaal consortium van partners uit de muziekwereld en de gezondheidszorg de bestaande live muziek praktijk van MiMiC steviger te verankeren in ziekenhuiszorg. De partners bestaan uit instellingen voor muziekvakonderwijs en ziekenhuizen uit Groningen, Den Haag, Londen en Wenen.Samen hebben alle partners de expertise om praktijkgericht onderzoek naar professionalisering van deze muziekpraktijk uit te voeren. Daarmee kan een bijdrage geleverd worden aan ontwikkelingen als uitkomstgerichte zorg, positieve gezondheid, en een bredere maatschappelijke inzet van musici.Live muziek in het ziekenhuis? MiMiC - Meaningful Music in Health Care – is precies dat: een kleine groep musici die persoonsgerichte improvisaties voor patiënten en verpleegkundigen speelt. De musici maken op de patiëntenkamers muziek ‘op maat’, in interactie met de patiënten, op basis van hun voorkeuren, herinneringen, etc. Dit levert waardevolle momenten van esthetische ervaring en zingeving op, voor zowel patiënten als verpleegkundigen en musici.Sinds 2015 heeft het lectoraat Lifelong Learning in Music van de Hanzehogeschool Groningen samen met het UMCG de MiMiC-praktijk ontwikkeld en onderzocht voor patiënten van chirurgische afdelingen. Persoonsgericht musiceren blijkt goed te realiseren in een medische setting en voor alle betrokkenen zeer betekenisvol te zijn. Patiënten ervaren minder pijn en voelen zich beter. Daarnaast biedt deze innovatieve praktijk musici en verpleegkundigen nieuwe mogelijkheden om zich professioneel verder te ontwikkelen. Daartoe willen we ProMiMiC uitvoeren.ProMiMiC speelt in op de behoefte van musici en verpleegkundigen om beter samen te werken en daarin van elkaar te leren, alsook om persoonsgerichte live muziek te kunnen gebruiken als katalysator voor een compassievolle patiëntrelatie. Met de verdere professionalisering van musici en verpleegkundigen is de MiMiC praktijk geschikt voor brede toepassing in de ziekenhuiszorg. Daarmee kan een bijdrage geleverd worden aan ontwikkelingen als Uitkomstgerichte Zorg, positieve gezondheid, en bredere maatschappelijke inzet van musici.In het consortium zijn uit drie landen hooggekwalificeerde kennisinstellingen op het gebied van muziek en van zorg gebundeld. Samen hebben zij de expertise om in een rijke context toegepast onderzoek naar professionalisering in MiMiC uit te voeren. Dit leidt tot een verbeterde uitvoering van de MiMiC praktijk en hierop aansluitende scholing van studenten en professionals in muziek en zorg. Dit zal musici en verpleegkundigen in staat stellen excellente professionals te zijn m.b.v. gepersonaliseerde live muziek in de zorg.
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