الفهرس 
Introduction
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Abstract
Music is one of the widely utilized forms of complementary therapy in psychiatry. It has numerous applications within the psychiatric settings such as improve concentration and attention span, increase relaxation. Social interactions, communication, relationships, learning, mobilization, expression can be enhanced by music. The interest in studying the patients’ and health care providers’ perception and attitudes towards the use of music as therapy in psychiatric hospitals will help enlighten the way for creating an adjunct medical treatment option in psychiatric hospitals.
The present study aimed to explore patients’ and health care providers’ perception and attitudes towards the use of music as therapy in psychiatric hospitals. The study followed a descriptive research design. It was conducted at the inpatient wards of El-Maamoura Hospital for Psychiatric Medicine.
The study Subjects comprised 130 inpatients with psychiatric disorders. The number of health care providers was 181 including 96 nurse, 63 psychiatrists, 8 psychologist and 14 social workers.
Four tools were used for data collection. The Attitude towards the Use of Music as Therapy Survey developed by McDaniel et al (2015) and used to measure the patients’ and health care providers’ attitude towards the use of music as therapy in psychiatric hospitals. Psychiatric Health Care Provider’s Perception of Music as Therapy Structured Interview Schedule developed by the researcher based on the tools of Stylinou et al (2010) and Grant et al (2013) and used to measure the health care providers’ perception regarding using music as therapy in psychiatric hospitals. Patient`s Perception of Music As Therapy Structured Interview Schedule developed by the researcher based on Travis et al (2003) and Grant et al (2013), in order to help patients express freely their perception about music as therapy. Additionally, A Socio-Demographic and Clinical Data Sheet were used.
The face and content validity of tools (I), (II) and (III) revealed that the studied tools are valid and reliable (r=0.997/ α=0.634, r=0.984/ α=0.901, r=0.991/ α=0.903 respectively).
A pilot study was carried out on 13 inpatients and 19 health care providers and confirmed that tools were clear and feasible. Written or oral consent were obtained from all participants. Data were collected through individual interview over a period of four months (December 2016 until March 2017).
The data were computerized and verified using the SPSS (Statistical Package for Social Science) version 20.0 to perform tabulation and statistical analysis.
The following were the main results of the present study:
Among studied health care providers 59.1% were females, 62.4% of them were in the age group ranging between 30 to 39 years old.
Health care providers with university degree represented 56.9% (Bachelor’s Degree 16.6%, Post Bachelor Diploma 8.8%, master Degree 24.9% and Doctorate Degree 6.6%).Those with three years secondary school nursing diploma amounted 22.1%, while those with two years post-secondary school diploma were 21 %.
More than half (50.8%) of the studied health care providers were nurses, 34.8% were psychiatrist,7.7% of them were social workers while only 4.4% of them were psychologist.
Health care providers with number of working years ranging between ten years to less than fifteen years of work represent 35.9%, those who had work experience more than 5 years to less than ten years are represented by 34.3% of the studied health care providers.
Health care providers currently working in a paid ward amounted to 47.5%.
The majority of the studied patients (66.9%) were males, the age ranged between 22 and 63 years old with a mean age of 36.95 ±7.27 years old, where 57.7% of them were in the age group ranging between (30- 39). About half of the studied patients (47.7%) lived in urban areas and 52.3% lived in rural areas.
Studied patients who had secondary education represented 40.0% and only 30.8% had university education.
Near half of the studied patients (46.2%) were single, 27.7% of them were married, while 18.5% were divorced.
Currently unemployed patients were 46.9% and 53.1 % were employed.
Studied patients admitted to nonpaid wards were 66.9 %.
Studied patients’ age at the beginning of illness ranged between 17 to 56 years with a mean of 27.04± 7.58 years, 69.2 % of them were in the age group ranging between 20 to less than 30 years at the beginning of illness.
The illness duration ranged between two years to twenty five years with a mean of 8.91± 5.57 years, 34.6% of the studied patients had duration of illness ranging between 5 to less than 10 years.
The length of hospital stay for the studied patients ranged from 23 days to 25 months, with a mean of 3.69± 3.96 months. The majority of the studied patients (83.8%) were hospitalized for one month to less than six months.
Among the studied health care providers 75.1% had high knowledge, 24.3% of them had low knowledge while only 0.6% of them had moderate knowledge about music as therapy.
Positive perception of music as therapy and of its effectiveness was found among 81.8% of the studied health care providers.
The studied patients who resorted use of music to confront their life stressors were 76.2%, 52.3% felt relaxed or calm after listening to music, 47.4% reported increasing the ability to function and 36.9% of the studied patients viewed that music helped initiating new relationship.
Studied health care providers who viewed that music as therapy can be helpful in increasing relaxation amounted 80.8%, those reporting that music is helpful in positive stress management, decrease manic-depressive symptoms and improve self- esteem represent 76.9%.
Studied patients who perceived that they could use music as therapy were 70.8 %. Only 29.2% of the studied patients reported that they do not support music as therapy. Lack of knowledge about music as therapy, lack of confidence in its effect and believing that music is a waste of time are the most common reasons presented.
Almost all studied patients (90.8%) reported individual meetings with the therapist as most helpful and 69.2% stated that they don’t know music therapy.
Studied health care providers who had positive attitude towards music as therapy were 70.7% compared to 12.2% of them had negative attitude.
The studied patients who had positive attitude toward music as therapy represent 66.2%, while 13.8% of them had negative attitude.
The percent of patients using music as a coping strategy represents 28.5%.
Significant positive relationships were found between gender, age and knowledge about music as therapy among the studied health care providers where (=5.256, p=0.047, =10.896, p=0.015 respectively). Also, there is a statistical significant relationship between years of experience in the psychiatric field and knowledge about music as therapy (=13.092, p=0.017).
There is a statistical significant positive relationship between healthcare providers’ gender, number of working years , years of experience in the field of psychiatry and perception of effectiveness of music as therapy among the studied health care providers (=4.624, p=0.032 / =11.747, p=0.008 / =15.567, p= 0.001).
A statistical significant relationship is also found between reporting being able to control the self as the effect of music on the studied patients and the level of education where = 6.433, p=0.040.
There is a statistical significant relationship between level of education and considering music is against religious faith or reporting that psychiatric disorder is an organic disease which can be only corrected by medications are reason for not supporting music as therapy (=6.313, p=0.046).
No statistical significant relationship between the attitude toward the use of music as therapy and demographic and working data of the studied health care providers.
No statistical significant relationship between the attitude toward the use of music as therapy and their socio-demographic and clinical data except with excitement as symptoms on admission, the treatment with combination therapy (=6.373, p=0.041/=7.491,p=0.041 respectively)
Statistical significant relationships were found between the health care provider’s knowledge, perception of music as therapy & perception of its effectiveness and attitude toward the use of music as therapy, (=135.166 P=<0.001, = 95.208 P=<0.00, =86.592 P=<0.001 respectively).
Based on the results of the present study, the following conclusions can be drawn. Patients have a positive attitude toward music as therapy. They appreciate the effect of music on themselves and other, in reducing stress, improving mood and controlling psychiatric symptoms. In spite of their low knowledge about music as therapy patients are in favour of such form of treatment.
Health care providers on the other hand, know about music as therapy, they perceive it as helpful in improving patients’ condition and ever decreasing the side effects of medications. Healthcare providers possess favourable attitudes towards music as therapy. Previous results pave the way for the possibility of using music as therapy in psychiatric settings.
In the light of the findings of the current study the following recommendations can be made:
IV- Recommendations for psychiatric health care providers:
• Workshops on the use of music as therapy as part of in-service programs should be offered in psychiatric settings in order to increase staff awareness and comprehension of this treatment modality. Training should be offered to all team members to enhance knowledge about the role of different members in implementation of music as therapy.
• Nurse should assume a more positive role in the implementation of music as therapy. They have to be able to choose the most appropriate time for their patients to listen to music. They should be also able to identify patients suited for music as therapy as well as the kind of music needed.
• Integrating music as therapy into the nursing and medical curriculum to ensure students are able to competently respond to and answer patients’ questions about music as therapy in patient care.
V- Recommendations for the patients with psychiatric disorders:
• Assessment of patient’s causes of not supporting the use of music as therapy, trying to clarify any misconception and promoting the way of benefit from the use of music therapeutically, in order to consider appropriate nursing care and intervention.
• Implementation of psycho-educational programs for patients to develop patients’ awareness about music as therapy.
• Integrating music as therapy into the plan of patient care to assure that the patient has a chance to try this type of therapy.
VI- Recommendations for future research:
• More future researches are needed to clarify the effect of music as therapy educational programs for health care providers and their efficacy to implement music as therapy.
• Further researches are needed to investigate the effect of music as therapy on the outcomes of psychiatric patients.