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The arts in healthcare: Past, present and future plans for the integration of the arts within medical facilities and treatment practices

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The arts in healthcare: Past, present and future plans for the integration of the arts within medical facilities and treatment practices

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Content THE ARTS IN HEALTHCARE: PAST, PRESENT AND FUTURE PLANS FOR THE INTEGRATION OF THE ARTS WITHIN MEDICAL FACILITIES AND TREATMENT PRACTICES by Cathryn Rachel Lee A Thesis Presented to the FACULTY OF THE SCHOOL OF FINE ARTS UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF PUBLIC ART STUDIES August 2005 Copyright 2005 Cathryn Rachel Lee Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. U M I N um ber: 1 4 3 5 1 1 4 Copyright 2005 by Lee, Cathryn Rachel All rights reserved. IN F O R M A T IO N TO U S E R S The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleed-through, substandard margins, and improper alignm ent can adversely affect reproduction. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. ® UMI UMI Microform 1435114 Copyright 2006 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Com pany 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 481 06 -1 34 6 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Dedications This thesis would not have been possible if not for the continued support of my loving parents who have always encouraged me to do my best and try my hardest. Your wisdom and sickness have been an inspiration and driving force behind this work. I would like to dedicate this work to my mom and dad, the kindest and strongest people I know. I would also like to dedicate this work to Kyle, for spending countless nights at hospitals around the world. I never could have come this far without you. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Acknowledgments I would like to acknowledge all of the professors and staff of the public arts studies program for their effort and vision in creating a program that furthers the arts in so many ways. I would like to especially acknowledge the guidance of Dean Weisberg for her commitment to the program and seeing that it continues to be a model for other schools around the country, Also, I would like to thank the dedicated members of my thesis committee for their tireless work and support on this project. I would like to thank my thesis chair, Kazys Varnelis for his help throughout this process. I would like to acknowledge and thank the wonderful medical and arts personnel at the University of Alberta Hospital who saved my father’s life and taught me that a hospital is the perfect place for art-1 am eternally grateful for all of their kindness and care. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table of Contents Page Dedication ii Acknowledgements iii List of Figures vi Abstract vii Chapter 1 - Introduction to Ideas, Structure and Goals 1 The Arts in Healthcare: A Needed Complement to Modern Medicine 1 Chapter 2 - Defining the Space of the Hospital: Users and Consumers of Healthcare and Identifying Places for Creative Opportunities 4 Arts and Hospitals: An Ancient Combination 4 The Hospital as Public Space 7 Medical Consumers and the Business of Health 7 Public versus Private: Places of Opportunity for the Arts in Healthcare 11 Better Buildings for Better Health 17 Chapter 3 - Evaluating the Positive Benefits of the Arts in Healthcare and Identifying Existing Best Practice Arts Programs 19 Arts Improving Health 19 Passive and Active: Defining the Arts in Healing 21 Passive Art: A Case Study 22 Active Art: A Case Study 24 Passive + Active = Performance 27 Chapter 4 - Opportunities, Places and Users of Arts in Healthcare: Surveys and Case Studies of Existing Programs 31 The Current State of Arts in Hospitals 31 Art and Cancer: Healing Through Creativity 33 Healing the Healers 35 Art for Children: Specific Programs for Specific Patients 37 iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter 5 - Ideas and Strategies for the Integration of the Arts within the Healthcare Community and Hospital Spaces 40 The Future of the Arts in Healthcare 40 Arts in Healthcare: Gaining the Support of the Medical Community 41 How to Proceed: Ideas for the Integration of the Arts in Healthcare 42 How to Proceed: Evaluating Resources 43 How to Proceed: Setting Program Goals 44 How to Proceed: Choosing the Right Program 45 How to Proceed: Community Involvement and Support 46 How to Proceed: Tailoring Programs to Users 49 How to Proceed: Creating Quantifiable Results 51 How to Proceed: The Future of the Arts in Healthcare 53 Bibliography viii Appendix A Art Programs of Interest x v Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. List of Figures Page Figurel Medical Mall, Dartmouth-Hitchcock Medical Center 10 Figure 2 Example of central public corridor, Queen Margaret General Hospital Dimfermline, West Fife, UK 12 Figure 3 Example of patient room, Bay Park Community Hospital, Oregon, Ohio 15 Figure 4 Central Public Atrium, University of Alberta, Edmonton, Canada 16 Figure 5 Passive art in Cedars-Sinai Hospital, Los Angeles, California 23 Figure 6 Shands Healthcare Healing Wall, Gainesville, Florida 26 Figure 7 Life Sciences Orchestra, University of Michigan 29 Figure 8 Smith Farm Artist-in-Residence Program, Washington D.C. 34 Figure 9 and Figure 10 Children’s hospital interior details, Yacktman Children’s Pavilion, Lutheran General Hospital, Park Ridge, Illinois 38 vi Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Abstract It has been proven that mental, auditory and visual stimulation improve a patients’ emotional state and recovery time however no studies exist that can definitively prove the healing properties of the arts within the field of medicine. Anecdotal evidence offers minimal support on the positive benefits of integrated arts programming in medical facilities and patient treatment. Scientific data must be collected and studies undertaken in an effort to further the use of the arts in the healing process. Hospital designers, medical consumers and medical personnel must become educated on the importance of holistic patient care that attends to mind and body throughout clinical treatment. The integration of the arts in healthcare is a necessary step forward in patient care in the medical marketplace. Technological advances continue to improve physical health without attention to emotional state, art programming can help rectify this disparity. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter 1- Introduction to Ideas, Structure and Goals The Arts in Healthcare: A Needed Complement to Modern Medicine Health has become a commodity. Patients in hospitals are treated with the most advanced technology available in an effort to maximize profit by moving the product of “getting better” more efficiently. Pushing through a system based on economy rather than well-being, the space of the hospital has become a transit hub for patients, visitors and caregivers. Advances in medical technology which work only to heal the physical being have replaced older methods of treatment which placed focus on the healing of mind and body in combination. A shift in treatment which approaches patient care holistically, treating patients’ emotional and physical selves in tandem, should be the next advancement in the field of medicine. This next phase of medical care can be achieved through the integration of the arts in healthcare, returning to ancient practices and non-western healing techniques that encourage the mitigation of mind and body. The arts practiced in areas of healthcare have been shown to have a positive effect on the physical and mental health of patients as well as on the speed of patient recovery. These observations illustrate that the arts in healthcare are economically advisable and a necessary addition to patient treatment. Educating medical professionals, hospital designers and patients 1 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. on the importance of mental stimulation, creative expression and emotional well-being on the healing process will bring the arts back into healthcare. Further understanding the users of medical facilities and the consumer culture of healthcare allows the arts to be integrated into hospitals as both a healing agent and an economic driver that caters to medical consumers originating from a diverse creative class. Placing art in an economic context as a way to increase revenue allows art to operate in the world of business which helps support programming and continue funding for existing and future projects. In lieu of significant scientific data that proves the positive effects of arts on healing, highlighting the economic benefits of such experiential programs in the modern medical market place can further the arts in healthcare. In order to sufficiently recommend approaches and critique current arts programs within medical facilities, it is necessary to identify key areas for discussion that define: the spaces of hospitals, the users of these spaces, places that offer the opportunity for arts integration, ways to receive funding and other support by producing quantifiable data and how to proceed in the creation of arts programs in existing medical facilities. This thesis investigates the current state of the arts in healthcare and offers suggestions for furthering the use of the arts within medicine to aid in healing. Prior to evaluating existing programs and proposing alternative approaches, it is necessary to look at the existing structure hospitals and the space they occupy in the public realm. Societal shifts have changed the 2 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. physical and social place of the hospital, creating a new paradigm in patient care which focuses on the consumer culture of modern times. This thesis is by no means the final answer on how to fully integrate the arts into modern medical treatment. It is a step on the road towards proving the need for the holistic treatment of patients by supplementing physical medicine with emotional creativity. It points to the public and private spaces of the hospital as places of opportunity to offer art to the masses using healthcare systems both in the long and short-term. The largest problem the arts in healthcare movement faces is the lack of scientific data that proves the power of the arts as a healing facilitator. It is my hope that this thesis will be used to support future efforts in the creation of arts programming that actively collect conclusive evidence that will definitively prove that art is as good for the body as it is for the soul. Professionals in the arts and medicine continually witness the positive physical and mental benefits that the arts have in hospital settings but testimonials are not enough. The medical and arts communities need to work together to offer scientific studies on both passive and active art programming and their effects on physical and mental health. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter 2 - Defining the Space of the Hospital: Users and Consumers of Healthcare and Identifying Places for Creative Opportunities Arts and Hospitals: An Ancient Combination The first hospitals began to emerge in approximately 1200 B.C. at a time when little was known about the human body and its inner workings. Records show that patients were often treated with dance performances, musical interludes and surrounded by sculptures and paintings donated by hospital patrons in addition to homeopathic remedies and prayer.1 In the Middle Ages, chanting was thought to lift up the spiritual self to overcome illness, bringing song into infirmaries in an effort to heal physical maladies. A shift came during the Renaissance when the Enlightenment placed a focus on scientific discovery which led to the end of use of the arts in healing. Today, however, the importance of art in healing is being reassessed.2 “That the arts can be therapeutic is not of course a new idea, but it is an idea whose time has come,” stated Sir Richard Attenborough in 1989, over a thousand years after ancient civilizations treated their ill through artistic means.3 In modern society technology has pushed art to the wayside in the treatment of the ill, favoring instead the creation of factory-like hospitals comprised of machines that move patients through like an assembly line. It 1 Richard L. Miller FAIA, and Earl S. Swensson FAIA, Hospital and Healthcare Facility Design: 2 n d ed. (New York: W .W . Norton & Company, 2002) 40. ^"Geoffrey Purves , Healthy Living Centres: A Guide to Primary Health Care Design. (Oxford: Architectural Press, 2002) 10-11. 3 Purves 78. 4 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. is time for art to become the next advancement in the treatment of a person’s mind and body in modern medical practices. It is the space of the hospital that dictates the interaction of art and medicine, providing places for the holistic treatment of patients by integrating the arts within the space of healthcare facilities. Modern hospitals are places of treatment and resolve which have the ability to grow and change over time in an effort to stay up to date with medical technology and advances in built environmental design. The community within the hospital is comprised of members of a larger public sphere that are in need of certain services provided by the medical facility. Although some hospitals are financed privately and are thus considered private institutions, the users of the hospital can still be understood as being a segment of the public that the hospital serves. Constraints imposed by the practice of medical insurance and the existing community located in the vicinity of the hospital actively shape the type of public within the hospital space. Changes in consumer attitude and shifts in cultural paradigms have come to favor experience over service in all areas of capitalist society. From eateries to medical facilities, an effort to appeal to growing consumer mentalities has led businesses to add experiential opportunities in tandem with goods and services provided. In the hospital marketplace where several facilities may offer identical services, there is a need to create medical spaces that fulfill modern consumer desires for unique experiences 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. in order to gain a greater percentage of market shares. The addition of art and art programming within hospitals offers consumers experience along with treatment which allows facilities with similar services to set themselves apart from one another. Art can facilitate the creation of meaningful experiences within medical spaces in conjunction with aiding in the physical and emotional healing process.4 In an effort to educate medical personnel and hospital directors on the importance of bringing the arts into the practice of healthcare, it is necessary to speak in the language of business. Approaching the integration of art in medicine as a way to heighten consumer experience and thus improve sales, hospital administrators would pay greater attention to the positive benefits of providing art within the hospital environment. Identifying the spaces within existing medical facilities that are readily accessible to patients, visitors and caregivers and offer a unique experiences through the use of art allows administrators the opportunity to integrate art directly into healthcare spaces. The built environment of the medical facility often dictates the places available for art displays, performances and art making. Understanding the differentiation between private and public spaces within the hospital allows for more informed and plausible proposals for the integration of art within the facility. 4Richard Florida, The Rise of the Creative Class: and How it’s Transforming Work. Leisure. Community and Everyday Life. (New York: Basic Books, 2002) 168. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. The Hospital as Public Space In the current climate of medical insurance policies, the care of patients has become regulated by the Federal government as well as individual State governments which have helped define both private and public hospitals as being available to all people. Within the United States, hospitals are required to treat seriously ill individuals admitted under emergency conditions, whether the person is financially stable or medically insured. The current policy referred to as the Emergency Medical Treatment and Active Labor Act (EMTLA), requires medical facilities to treat all emergency patients until they are stable enough to be transferred to a facility of their choice or a facility financed by their medical insurer. The EMTLA ensures public access to medical care as well as to medical facilities, making hospitals public space by law.5 Medical Consumers and the Business of Health People who receive medical care, referred to as medical consumers have been broken down into six distinct groups by a 1990 Gallup poll. These groups have been identified by age, sex, marital status and income in an effort to understand who uses medical facilities currently and what their needs will be in the future. These six groups have been given names that 5 “ Overview of Laws that Help the Uninsured Access Healthcare” Health Assistance Partnership. <http://www.healthassistancepartnership.org/site/PageServer?pagename=Uninsuredoverviewlaw s> 7 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. describe their overall characterizations: The Young and Skeptical, The Self Reliants, The Secure and Satisfieds, the Passives, The Coping but Concerned and the Struggling Singles. The largest of these groups, the Secure and Satisfieds make up approximately 24% of medical consumers and have been identified as highly educated men and women in their mid forties who are generally happy with their medical care but support a standardized federal healthcare system.6 The five remaining groups range from 13% to 18% each of medical consumers, making the majority of hospital users falling into the category of Secure and Satisfied. The findings from the 1990 Gallup poll have been used to understand the current and future uses of hospitals, shaping the way hospitals are designed and organized for higher efficiency. Identifying the chief consumers of medical services, hospitals have begun a capitalist approach to medical care. Patients are referred to as healthcare consumers who purchase goods and receive services in the healthcare marketplace.7 The idea of the hospital as marketplace has led to improved design of hospital spaces which integrate public and private spaces much like other consumer spaces. This consumerist attitude has created a systematic approach to treatment that neglects the emotional well-being of the ill and places excessive focus on the efficiency of physical healing. Placing the hospital in the context of consumerism allows it to function in the public sphere as a 6 Miller and Swensson, 16-17. 7 Miller and Swensson, 16-17. 8 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. service center, providing goods and services for a certain segment of the population. In the 1970’s, the idea of the medical mall was born. The design concept behind the mall-type layout was believed to have a humanizing and de-stressing effect on hospital visitors providing them with a familiar design scheme which mimicked the common shopping mall. The medical mall structure, now the most common type of modern hospital construction, was realized in the Iate1970’s with the creation of the first official medical mall in Dallas, Texas. The bundling of certain procedural spaces allowed for the creation of “non-critical” spaces to continue the humanizing of the facility by adding spaces for normalizing activities. These “non-critical” spaces became the first designated public areas within modern hospitals.8 The medical mall, illustrated by the Dartmouth-Hitchcock medical center in figure 1, employs similar aesthetic principals in a hospital setting that are used in shopping center environments. Awnings on the ground floor level, lighting fixtures and open viewing access from all floors makes this space less imposing and also creates an interior layout that is familiar to visitors and patients. Miller and Swensson, 67-69. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Fig. 1. Medical Mall, Dartmouth-Hitchcock Medical Center courtesy of Shepley Bulfinch Richardson and Abbott in Richard L. Miller, FAIA and Earl S. Swensson, FAIA, Hospital and Healthcare Facility Design. 2n d ed. (New York: W .W . Norton & Company, 2002) 70. In the design of new hospitals or the remodeling of older facilities, the desires of medical consumers are evaluated and designs are created in an attempt to address them. Studies have pointed to four central areas of the built hospital environment which are most important to patients and visitors: physical comfort, social contact, symbolic meaning and wayfinding.9 Although these four points can be solved through appropriate building design that takes into account the concerns of the users, these points may also be met through art as interior decoration or through interactive art activities. The medical mall structure attends to all four major concerns by: providing users with a floor plan that is easy and comfortable, creating spaces that are public and invite social interaction among different groups, adds clear systems for wayfinding similar to those available in large 9 Miller and Swensson, 65. 10 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. shopping complexes and provides patients with a familiar building model that creates positive symbolic environments.1 0 Public versus Private: Places of Opportunity for the Arts in Healthcare Every piece of the built hospital environment, much like the pieces that comprise the average mall, serves a unique role which gives the facility the ability to evolve and change over time as greater understanding of the medical field is gained. Bigger hospitals which are largely self sufficient share similar planning strategies as towns including the existence of a publicly accessible main corridor of movement with smaller, more private spaces radiating out from this space. The floor plan of the Queen Margaret General Hospital in the United Kingdom, figure 2, is a clear example of main public corridor design. The central public corridor is flanked by private and semi-private spaces and areas with specialized functions which form smaller units that face publicly accessible inner courtyards. Typically, the built space of the hospital is designed around this central public artery which allows for faster movement of goods and services throughout the facility. The main public way is then broken down into smaller public and private spaces which makeup the whole of the medical facility.1 1 1 0 Miller and Swensson, 65-66. 1 1 Tony Monk, Hospital Builders (Great Britain: Willey-Academy, 2004) 34. 11 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Fig. 2. Example of central public corridor, Queen Margaret General Hospital Dimfermline, West Fife, UK from Tony Monk, Hospital Builders ( Great Britain: Wiley-Academy, 2004) 87. In older hospital facilities the strict delineation of private and public spaces has been achieved by creating symbolic environments, universally understood visual cues that alert visitors, staff and patients to the level of access or restriction to each space.1 2 Public spaces may be defined using courtyards, seating, constructed views, color designation and art work while private spaces are often closed off from the main corridor either by physical placement or barriers. The definition of these public versus private spaces allow for the creation of social hierarchies and relationship building between individuals that occupy certain defined spaces.1 3 In newer hospitals, the importance and use of public space is integrated into the total design of the 1 2 Wilbert M. Gesler, Healing Places. (Lanham: Rowman & Littlefield Publishers, Inc. 2003) 91-93. 1 3 Gesler, 91-93. 12 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. facility, often creating open areas for public activity that act as the central focus for programming. The public spaces available in hospitals are used by a variety of people: patients, staff, volunteers and visitors. Interior areas designated for use by visitors are similar in most hospitals and generally include: waiting areas, cafeterias, hallways and lobbies. Modern hospitals have added amenities like small stores, coffee kiosks and art galleries to the list of available public places. These spaces can be broken down by how they are accessed by users and who the users are. Some of these public spaces become semi public when access to them is limited to certain groups, like specialized waiting areas. Rooms become more private as they move away from the main public space, limiting access and providing a quieter environment. Spaces providing a greater sense of privacy are necessary for the varied needs of hospital users. Private spaces often include: patient rooms, certain procedural spaces, surgical areas and staff lounges. In some situations, private waiting rooms are provided to visitors. Places like patient rooms may be considered semi-private as they may be accessed by members of the public with permission. The space of the patient room is unique to the hospital environment. Private or semi-private, the patient room can create a sense of isolation, leaving patients detached from the world around them. Early hospitals began as large wards which consisted of walls of beds divided by simple 13 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. fabric curtains that could be drawn closed for added privacy. Over time the separation curtains became walls and patient rooms became private areas of seclusion, closing the sick off from public space within the hospital building itself and from the larger public sphere outside. Modern understanding of environmental conditions on illness has highlighted the need to redefine the patient room by integrating mental stimuli, comfortable amenities and creating contextual connections to physical space within this private space. Updated patient rooms now may include expanded areas for visitors, windows where possible with views to the surrounding landscape and greater integration of medical equipment into the room decor in an effort to minimize the abnormal experience of a hospital stay.1 4 Utilizing hospitality models, the patient room has become a space of comfort and style. Colors, artwork, light and amenities are carefully chosen to minimize the sterile environment of the hospital. Figure 3 illustrates the new standard in inpatient rooms. Maximizing natural light and concealing noisy medical equipment helps create normalizing semi-private spaces that facilitate emotional rehabilitation in combination with medical treatment. Patient rooms often provide places for displaying cards, flowers and gifts. These places offer opportunities for the integration of art into the setting of patient spaces by appropriating existing display areas for the addition of artwork, supplied by either the patient or the facility. Approximately 25% of hospitals in the United States allow patients to choose the artwork displayed in their room and what art activities they would like to have take place at 1 4 Miller and Swensson, 211. 14 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. their bedside.1 5 Giving patients the opportunity to customize their room gives them a sense of ownership and control which they may not have in their medical treatment. This allows the patient room to act as a humanizing agent by giving patients choices in their environment by expressing creativity through art. Fig. 3. Example of patient room, Bay Park Community Hospital, Oregon, Ohio, NBBJ Architects from Joe Boschetti ed. Health Spaces: a pictorial review, volume 2 (Australia: Images Publishing Group Pty Ltd, 2003) 89. At the University of Alberta Hospital in Edmonton, Alberta, public space acts as the central spine of the facility as illustrated by figure 4. Accessible from several entrances, two main stairways, and two public elevator systems, and visible from most locations in the hospital, the public space is useable by all people using the facility. The public space serves many functions and is used as a waiting room, cafeteria, patient visiting area, shopping space and outpatient pharmacy. The central public foyer is the 15Naj Wikoff, “ Cultures of Care: A Study of Arts Programs in U.S. Hospitals.” Monograph: Americans for the Arts. November 2004: 3. 15 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. main focus of the building, highlighting the importance of public space within the hospital environment. Off the main public space, an art gallery and interactive art space serve the entire hospital community. The central public space is smartly designed with electrical outlets to plug in patients’ medical equipment and wheelchair accessible tables of appropriate height so patients may share normal activities like eating pizza, with visitors. Fig. 4. Central Public Atrium, University of Alberta, Edmonton, Canada. Photograph Courtesy of Kenneth David Lee, Architect, AIA 2004. Continued research into the therapeutic opportunities provided by the built hospital environment has led to a more integrated approach to the design of better spaces for wellness. The continued improvement in building design has allowed for positive changes in the physical hospital environment and lessened the distinction between purely private and public spaces, understanding the importance of spatial relationships in the field of healthcare. Understanding the effects of the built environment on hospital 16 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. users and adapting designs to maximize functionality and aesthetics supports efforts to integrate art into medical spaces as well as physical treatments. Addressing the desire of medical consumers to engage in meaningful experiences while receiving other services like medical treatment, art can be a positive addition to hospital interiors which are often non-descript and sterile. Providing opportunities within the built environment for art activities, performances and exhibit spaces is a necessary consideration for future hospital construction for the holistic care of patients. Supplementing physical treatment spaces with decorative and participatory art allows for the integration of art directly into the healing process. Better Buildings for Better Health In tandem with the reinterpretation of the space of the hospital, a new attitude must be adopted by the medical community. The Hippocratic Oath underlines the delicate balance between mind and body as an essential part of treating the ill. Every doctor has that has recited this oath has made a promise to respect the connection between the emotional and physical self of each patient. It is each doctor’s responsibility to reconcile both parts, advocating a holistic approach to the treatment of the ill.1 6 Modern medicine has placed too great an emphasis on the science of the physical and not enough importance on the emotional distress caused by painful treatments 16Purves, 10-11. 17 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. and sterile hospital environments. As the built hospital environment works to integrate advances in social and emotional theory, the staff that works within these spaces must understand that technology does not heal all that ails. The combination of technology and art can make strides towards the total treatment of patient’s mind and body. Patients should not be rushed through medical factories which work only to heal physical ills, rather they should be provided with choices, spaces and opportunities to continue to act as individuals with emotional needs, regardless of affliction. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 18 Chapter 3 - Evaluating the Positive Benefits of the Arts in Healthcare and Identifying Existing Best Practice Arts Programs Arts Improving Health Historically, hospitals were created as warehouses for the sick, an institutionalized way to prevent the spread of disease by isolating the ill away from the healthy. Without fully understanding how certain diseases were spread, containing the sick was the best attempt at stopping full scale epidemics.1 7 The perception of hospitals as storage spaces for disease continues but has lessened with improved public relations programs and the public’s greater understanding of disease. The goal of the hospital has remained constant over time. Hospital facilities and their staff aim to improve physical health of ailing patients using modern technology and advances in medical methods. Breakthroughs in medicine have allowed patients to live longer, have a better quality of life and heal more rapidly however treating the emotional health of a physically ill patient is still far behind medical science. Recent observations have shown that art making as a form of mental stimulation as well as gallery-style art collections can have a positive effect on both emotional and physical health of hospital patients, visitors and caregivers.1 8 Significant research has been conducted regarding the effects of the built interior environment of mental institutions on mentally ill patients. 1 7 Miller and Swensson, 38-42. 1 8 M. J. Friedrich, ‘The Arts and Healing”, JAMA. 19 May 1999. 19 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Studies including mental responses to colors, sounds and smells have led to an increased understanding of the brain function and reaction of patients allowing for greater control by institution staff.1 9 Research on physically ill patients in non-specific hospitals is less prevalent. One study conducting in 1972 illustrated the importance of mental stimuli on the emotional health of postoperative patients by observing those patients in rooms without windows to the outside had a 40% greater likelihood of developing psychosis while those patients in rooms with windows had only an 18% of developing the condition.2 0 A similar study conducted in 1984 found that postoperative patients with views of naturalistic foliage needed less medication, experienced fewer complications related to surgery and had shorter hospital stays than patients with views of brick walls.2 1 Controlled studies have shown the importance of visual stimulation in the healing process of physically ill patients which can be provided by the integration of art into the healthcare environment. Lacking in statistical proof, it is apparent from patient and staff statements that art making within hospitals greatly improves attitudes, energy levels and emotional health of patients and caregivers. A report released by the Washington Cancer Institute last year touted that a third party artist-in-residency program which provides arts activities to cancer patients “[has] brought much care, respect, creativity, energy, innovation and nurturing to the [facility] as a whole...Their 1 9 Albert Mehrabian and James Russel, An Approach to Environmental Psychology. (Massachusetts: MIT Press, 1974) 59-66. 20 Gesler, 87-88. 2 1 Robert Ulrich, “A View Through a Window May Influence Recovery From Surgery”, Science Volume 224, April 1984. 20 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. benefit and effect are easily noticed in the attitude and actions of those [the artists] have spent time with.”2 2 Passive and Active: Defining the Arts in Healing Current art programming within hospitals can be classified as passive, meaning art hung on walls or sculptures in lobbies or active, meaning interactive programs with fixed schedules that invite art making by patients, staff and volunteers. Performance art including: dance, music and theater is classified as both active and passive because it requires the engagement of an audience but does not require active audience participation. Passive art exists within many hospital complexes. It can be found in public spaces such as waiting rooms, lobbies and hallways or in more private spaces like patient rooms and areas designated for specialized care. Passive art is limited to gallery-like assemblages of artistic work that has limited therapeutic effect on visitors by adding visual stimulation to the hospital space. Although less engaging than active art programming, passive art has a positive impact on hospital users by providing spaces that are both mentally and visually stimulating. The following case studies identify three exemplary arts programs that illustrate different ways in which the arts can be integrated into hospital spaces and treatments. Programs of interest were chosen by the program’s 2 2 “Hospital Artist-in-Residence Program” Smith Farm: The Arts in Healing Center. Pg 2 of 2, March 2005. <http://www.smithfarm.com/healing.html> 21 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. strong reputation in the arts community as well as from first hand experience. Each case study emphasizes the positive influence that the arts have on patient health regardless of art type. The delineation between passive and active art programming is unique to this thesis and adds clarification to the discussion of the arts within medical facilities. Each study addresses a unique type of art program within the hospital environment which includes: passive art, active art and a combination of the two being performance art. Passive Art: A Case Study Cedars-Sinai Medical Center in Los Angeles has an extensive collection of paintings, sculpture and mobiles. Each hospital floor has a significant exhibition of important works by world renowned artists including pieces by: Pablo Picasso, Andy Warhol and Alexander Calder. Artworks are carefully displayed in public places like waiting rooms and hallways to maximize viewing potential. Beautifying the unremarkable design of the hospital interior, the collection is impressive in size and importance but does not invite more then passive viewing. Figure 5 captures a conventional hallway art display at Cedars-Sinai hospital’s south inpatient tower. Artwork hung in high traffic areas like hallways must be durable and uncontroversial, acting as decoration and as a system of defining similar spaces. 22 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Fig. 5. Passive art in Cedars-Sinai Hospital, Los Angeles, California. Photograph by Author The therapeutic effect of passive art is important to the perception of the care quality perceived by perspective patients and staff. Studies have illustrated that patients enter hospitals with certain expectations regarding the care they will receive from a hospital based on visual cues from the built hospital environment, including interior decor.2 3 Aspects such as art collections give added legitimacy to an institution, improving the perceived status of the facility among patients, visitors and staff. These studies highlight the inherent understanding that passive art improves the therapeutic nature of a space. Without actively engaging patients, passive art has the ability to visually stimulate visitors, create an added sense of well-being and improve positive perception of a hospital space. In order for passive art to be a positive benefit to the hospital environment selected pieces must be perceived as being pleasant by having a calming effect without being challenging or confrontational to the viewer. Hospitals with 23 Gesler, 89. 23 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. specific gallery spaces have a greater opportunity to provide visitors with more polarizing art than those pieces hung in highly public areas.2 4 Active art programs often combine aspects of passive programs along with interactive art making endeavors which have the ability to create significant interactions among patients and staff, lessen patient stress and improve emotional well-being of the sick.2 5 In combination with creating opportunities for mental stimulation, the act of art making can simply delight patients. Giving hospital residents an outlet to express fears, desires and appreciation, art making allows patients to become removed from their physical ailments, an important respite from the abnormal circumstances which they face. Active Art: A Case Study The Shands Medical Center located in Gainesville, Florida is connected with the University of Florida. Comprised of several specialized medical facilities as well as a large teaching hospital, the importance of art is central to Shands approach to holistic patient care. Creating the Arts in Medicine Program (AIM), Shands has been a widely successful example of the positive effects that both passive and active art has on hospital users. The 24 Wikoff, 8. 2 5 Anne Ridenour, ‘The Arts in Health Care Settings”, JAMA. 4 February 1998. 24 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Center’s advances in art programming has been used as a model for several hospitals’ art programs around the world.2 6 Combining passive and active art opportunities allows patients to see beyond their ailments with hope for the future, an important healing tool for emotional well-being. Projects like the “Healing Wall”, figure 6, located in the atrium of Shands Cancer Center gave 500 cancer patients and their families the opportunity to create colorful tiles during weekly painting sessions. The completed works were fit into a large wall that envelopes the atrium, humanizing the atrium by making it more personal and giving the space a touch of inspiration and hope. A similar tile painting project was employed during the renovation of Shands Children’s Hospital in a project entitled “Things are looking up.” Child patients, hospital staff, community volunteers and family members were invited to create ceiling tiles with inspirational messages to current and future patients. Painting is ongoing and takes place both in designated areas and in special bedside sessions for seriously ill children. This AIM project has allowed community members to become involved in hospital activities and has improved the overall physical and mental environment of the Children’s Hospital 2 7 26 “Shands Healthcare Projects” Shands Healthcare. Pg 1 of 3 ,1 7 March 2005 <http://www.shands.org/hospitals/UF/AIM/projects.htm> 27 “Shands Healthcare Projects” Shands Healthcare. Pg 2 of 3, 17 March 2005 <http://www.shands.org/hospitals/UF/AIM/projects.htm> 25 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Fig. 6. Shands Healthcare Healing Wall, Gainesville, Florida. Image courtesy of Shands Healthcare, <http://www.shands.org/hospitals/UF/AIM/projects.htm> Although visual art is the most visible product of AIM’s programs, several artistic disciplines have been included in an effort to have wide appeal to patients. AIM supported activities include: a volunteer-run atrium piano, storytellers who have bedside visits with patients and collect narratives for reproduction in a hospital magazine geared towards adolescents, a living room area with ongoing projects and activities, an artist-in-residence program, an interpretative dance troupe and an improvisational theater group that regularly interacts with patients and staff. Other activities include the Brown Bag Cafe program which invites community members and hospital staff to share their talents with patients and peers as well as a the Circle Art Studio located in the pediatric operative wing meant to relieve tension in children waiting to be taken to surgery.2 8 In addition to stimulating mental creativity, some artistic programs like dance and theater projects integrate physical exercise into their curriculum, allowing the arts to act as healthcare. 28 “Shands Healthcare Projects” Shands Healthcare. 1-3, 17 March 2005 <http://www.shands.org/hospitals/UF/AIM/activities.htm> 26 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. AIM coordinates levels of activity to the abilities of patients, being careful to choose programs that will not add stress to participants. Programs like the storytellers and improvisational theater allow patients to share experiences with others creating a community atmosphere within the hospital. The AIM program at Shands Medical Center is a highly developed example of the integration of the arts with medical care in an effort for the holistic treatment of patients. The AIM program is a unique example of a large hospital facility that engages patients of all types and illnesses in the act of active art making. Other medical facilities have chosen to integrate passive and active art in a less hands-on way. Passive + Active = Performance The University of Michigan Health System (UMHS) arts program pays particular attention to the emotional needs of medical staff, gearing its programming towards arts activities that can fulfill staff interests and serve the hospital community. The facility contains a large gallery that houses 54 different exhibits during the year. The continuously revolving exhibit schedule holds the interest of long-term patients and invites viewing by short-term visitors, allowing the gallery to become a destination within the facility. It is estimated that almost 10,000 people a day view the gallery collection with exhibits ranging from two-dimensional paintings to three- dimensional sculptures. In addition to invited artists, the gallery holds a 27 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. special yearly exhibit of staff-made art which gives patients an opportunity to learn more about their caregivers and allows staff to express themselves in a creative manner.2 9 The arts program at the UMHS relies heavily on performances in public areas of the facility, allowing all patients and visitors the opportunity to enjoy and benefit from arts programming ranging from theatrical productions to live music. One performance group, The Life Sciences Orchestra (LSO), combines medical students and staff within a large symphony orchestra that performs on a regular basis at the hospital for patients and in traditional performance spaces for the larger University community. The only such orchestra in existence, the LSO combines a world-class conductor with musically inclined members of the life sciences community which include participants from the fields of dentistry, pharmacology, nursing, and bioengineering with students within these fields. Figure 7, a photograph taken during a recent LSO performance, highlights the orchestra’s goal of sharing the musical talents of students and professionals in the life sciences with patients, medical staff and community members. The LSO has given students a chance to form personal relationships with professionals within their areas of interest and has given medical personnel a creative outlet for the stresses of their demanding occupations. 29 “Gifts of Art Home Program”, University of Michigan Health System 1-3,11 May 2005. <http://www.med.umich.edu/goa/programs.htm> 28 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Fig. 7. Life Sciences Orchestra, University of Michigan, photograph by Paul Jaronski, from Naj W ikoff, “Cultures of Care: A Study of Arts Programs in U.S. Hospitals, Monograph: Americans for the Arts. November 2004: 6. In addition to supporting the emotional health of the orchestra participants, concerts given by the LSO support the healing process of patient audience members. A German study in 1997 observed that live music reduced pain in cancer patients and found that patients’ heartbeats slowed in response to music tempo, calming patients without the use of sedatives.3 0 In addition to the performances staged in public spaces within the UMHS medical facility, musical performances also take place in semi-private areas of the facility. A bedside music program invites professional musicians into specialized wards to bring the calming effects of music to patients most in need. Musicians perform in the intensive care unit, the neonatal unit, dialysis center, burn and trauma unit and the pre- and post-surgery areas.3 1 Patients in these particular units are often physically unable to participate in 30Purves, 10-11. 31“Gifts of Art Home Program”, University of Michigan Health System Pg 2 of 3, 11 May 2005. <http://www.med.umich.edu/goa/programs.htm> Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. active art making programs but do positively benefit from the addition of music to the environment. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter 4 - Opportunities, Places and Users of Arts in Healthcare: Surveys and Case Studies of Existing Programs The Current State of Arts in Hospitals Passive and active art have their place within the hospital environment, each with a different level of interaction required by the viewer or creator. In the case of art programs within hospitals, special attention must be given to the emotional and physical needs of those involved, whether they are patients, visitors, caregivers or staff. The type of passive art chosen to grace walls or the amount of activity associated with hands-on art making must be tailored to the population that it serves. Understanding the emotional needs of patients, their physical abilities and the spaces in which they spend the majority of their time allows art programs to address the individual needs of certain types of illnesses and patients. A recent survey conducted by Society for the Arts in Healthcare (SAH) in conjunction with the Americans for the Arts found that approximately 50% of American hospitals have some form of arts programming, meaning that there are approximately 2,000 facilities with art programs in the United States. 73% of these art conscious hospitals have permanent gallery spaces or passive art displays while only 36% provide interactive art making for patients.3 2 The disparity between passive and active art programming may be due to the increased funding, staffing and maintenance perceived to be associated with hands-on programs. Another 32 Wikoff, 1-11. 31 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. factor may involve the needs and diminished physical capacity of the patients being served. The divide between active and passive art appears to lessen at hospitals and medical facilities which treat specific of kinds of patients or types of illnesses. Countless examples of active art programs can be found in children’s hospitals where the patients may not have the emotional tools necessary to understand, come to terms with, or react to their health problems. Several arts programs can be found at facilities which treat different types of cancers, where patients experience similar treatments and side effects but few active programs exist in larger hospitals that serve a variety of patients. The disparity between passive and active art seems to be greatest at larger hospital complexes. Massive medical facilities have the task of fulfilling the needs of many types of patients including: the terminally ill, long-term and short-term patients. These patients spend varying lengths of time at the facility, undergo different treatments during their hospital stay and require diverse levels of emotional support which can be provided by active and passive art. In institutional medical spaces which serve numerous types of patients, passive art may have the greatest impact on hospital users due to the complexity of the population being served. In medical facilities where active art can be more readily applied, patients share commonalities which allow them to create meaningful relationships with each other as well as with volunteers and medical staff using shared experience as a starting point. 32 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. In places which address specific illnesses and certain types of patients like cancer treatment centers and children’s hospitals, the task of identifying a program’s audience is already done. The specificity of the users allows art making activities that address individual aspects of an illness or treatment and gives patients the opportunity to share their concerns with others in the same position. In specific treatment centers and hospitals, patients may be offered a variety of activities and spaces that help lessen the emotional duress of the disease. Art and Cancer: Healing Through Creativity Smith Farm Center for the Healing Arts operates within the Washington D.C. metropolitan area. The center arranges and implements active art making within local cancer treatment facilities with a focus on inner city hospitals. The center is in its second year of an artist-in-residence program which places specially trained artists within hospital facilities on a regular basis allowing them to observe patient progress and reaction as well as create meaningful relationships with the ill.3 3 The abilities of the patients dictate the type of art which is created, tailoring art making to each individual. A broad range of artistic disciplines are covered by program participants including: visual art, creative writing, poetry, music, dance and 33 “Hospital Artist-in-Residence Program” Smith Farm: The Arts in Healing Center. Pg 1 of 2, March 2005. <http://www.smithfarm.com/healing.html> 33 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. storytelling. The range of activities allows patients of all physical and mental abilities the opportunity to become involved and benefit from the program. Artists visit patients in several locations within the hospital using mobile studios as seen in figure 8. Bringing art activities to patients most in need ensures the program’s maximum benefit to users. The patient in figure 8 engages in art making while receiving treatment, allowing the art to be complementary to medical treatment and acting as a distraction from discomfort. Fig. 8. Smith Farm Artist-in-Residence Program, Washington D.C., Image courtesy of Smith Farm Center for the Healing Arts, http://www.smithfarm.com/healina.html “Sometimes life beats us down and robs [a patient] of [their] soul, the arts remind [them] that [they] have one,” Stella Aldler, an administrator and participant for Smith Farm Center remarked.3 4 The humanizing effects of art making and active creativity are not readily studied but have repeatedly been witnessed by volunteers, artists and patients. There is no way to quantify the recovery of an ill person’s soul but by supplying patients with the tools and opportunity to express themselves in a creative way it allows patients to move beyond the pain and emotions of the disease. Through 34 “Hospital Artist-in-Residence Program” Smith Farm: The Arts in Healing Center. Pg 1 of 2, March 2005. <http://www.smithfarm.com/healing.html> 34 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. various forms of art making that make programs like Smith Farm Center have shown that active art programming is integral in the advancement of holistic patient. The artists involved with Smith Farm Center undergo a series of training sessions to prepare them emotionally and mentally for the experiences that they may have during their involvement with the program. This training is vital to the success of a long-term program which places artists with terminally ill and dying patients on a daily basis. Artists learn how to cope with and be open about their feelings regarding relationships and loses they suffer throughout their time in-residence. The special attention paid to the artists’ emotional state allows the program to keep a full staff of ready volunteers visiting hospitals each day. Their training gives them the emotional tools needed to engage themselves regularly with patients that may not be there tomorrow.3 5 Healing the Healers In addition to the artist-in-residence program aimed at patients, Smith Farm Center offers interactive retreats for medical students, practicing doctors and other medical staff. According to the SAH survey, of the 2,000 existing art programs, 55% of these provided arts programming for 3 5 “Hospital Artist-in-Residence Program” Smith Farm: The Arts in Healing Center. Pg 1-2, March 2005. <http://www.smithfarm.com/healing.html> 35 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. caregivers who include: doctors, medical students and nurses.3 6 These sessions allow caregivers to express their personal feelings in an appropriate environment outside the hospital setting. Retreats provide doctors the opportunity to share their experiences and understand the emotional magnitude of their situations. Participants often share their frustration at not being able to adequately show their deep caring for patients they are treating in an effort to remain within professional boundaries. Medical practitioners relay feelings of being “burned out” by working within such confines. Often doctors worry that they are too emotionally removed to care significantly about their patients. In a presentation given by Shanti Norris, executive director of Smith Farm Center she quotes Dr. Rachael Naomi Remen, “[caregivers] burn out not because [they] don’t care, but because [they] don’t grieve. [Caregivers] burn out because [they] have allowed [their] hearts to become so filled with loss that [they] have no room left to care.”3 7 The increased complexity of patient care combined with the continued goal of maximum efficiency of treating the ill has left many caregivers emotionally distressed. As the total number of patients increases and overall interaction time with individual patients decreases it becomes necessary for doctors, nurses and volunteers to find ways to alleviate emotional burn out. Shanti Norris concludes her presentation, “creativity can help this process.”3 8 36 Wikoff, 5. 37 Wikoff, 5. 38 Wikoff, 5. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Art for Children: Specific Programs for Specific Patients Art programs that focus on one type of patient or the needs of specific groups like caregivers allow individuals to interact and form relationships based on shared experiences using art making as a catalyst. Programs that operate within specialty hospitals like those facilities that treat children: have the ability to create connections between patients, families and caregivers while offering a creative outlet and positive distraction from the stresses of treatment. Children’s hospitals are often designed with a greater sensibility towards the user, offering whimsical touches that lessen the institutional quality of the hospital space. The design goals of the built environment of a children’s hospital are different from regular medical facilities which favor efficiency, economy and aesthetics. To create a successful children’s hospital, designers must provide spaces for interaction between peers, allow for patients to claim personal territory, give patients a sense of independence, give access to outdoor spaces and provide patients with a sense of fantasy and whimsy that stimulate the imagination.3 9 The use of bright colors, playful imagery and social activities like art making provide young patients with a distinct environment not often found in grown-up medical institutions. Figures 9 and 10 illustrate unique ideas in creating an inviting environment for child patients. Using playful symbols and distinct child-friendly themes allows normal hospital spaces to become areas of 3 9 Miller and Swensson, 304-305. 37 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. imagination and interactions. Identifying and addressing the needs of these unique patients allows for the integration of art programs that can help patients at their most vulnerable. Fig. 9. and Fig. 10. Children’s hospital interior details, Yacktman Children’s Pavilion, Lutheran General Hospital, Park Ridge, Illinois, from Barbara Crisp, Human Spaces: Life- Enhancing Designs for Healing. Working, and Living (Massachusetts: Rockport Publishers, Inc, 1998) 175. The creation of specialized child-friendly environments within the framework of the hospital attempts to lessen the tension caused by childhood disease. Within these child-geared environments, active art programming can help children express concerns they may not be able to vocalize and reveal feelings that they may not be able to share otherwise. Fostering creativity through engaging in art making activates a child’s imagination and allows young patients to take a mental respite from the stresses of being ill. According to a recent article from the Journal of American Medical Association: I 38 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Art helps children forget that they are ill while being in a strange place that otherwise might be frightening. Art connects children to delight and discovery and brings back some of the experiences of being a child, no just a sick child.40 Specialized projects that allow young patients to customize the space of the hospital facility aid in creating normalizing places and experiences for ill children. Encouraging child patients to create items to decorate and personalize their rooms or treatment areas allows them to develop a sense of ownership and control that they may never have experienced. Functioning as both an element of decoration and as a way for children to convey emotions that they not be able to share otherwise, making art gives young patients the ability to express themselves in a traditionally child-like manner. The pictures drawn or objects made can offer caregivers the opportunity to gain a greater understanding of the patient’s mental state and fears and addressing them appropriately. Active art programs invite children to exercise their imaginations along with inviting social interaction between peers. Mental stimulation in the form of art making keeps patients’ minds active during times of physical exhaustion due to treatment and boredom caused by long stays in the hospital environment. Programs that target children sometimes occur in places that elicit tension like pre and post operative areas as well as treatment spaces like dialysis treatment room and chemotherapy wards. 40 Anne Ridenour, “Creativity and the Arts in Health Care Settings”, JAMA. 4 February 1998. 39 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter 5 - Ideas and Strategies for the Integration of the Arts within the Healthcare Community and Hospital Spaces The Future of the Arts in Healthcare Art in combination with modern medical treatment is the future of patient care. The increased understanding of the importance of treating patients holistically will further the integration of the arts within medical facilities and aid in the creation of art treatment programs. With economy, efficiency and aesthetics being the top priorities in the design of new hospital spaces, it is necessary to institute programs that integrate art within existing programmatic and structural spaces. Art programming that is designed to function within the existing hospital model can serve older facilities while acting as an example for the integration and specialized design of designated spaces for passive and active art in future medical facilities. In order to gain funding and support from the medical community for art programming, it is necessary to bring the positive benefits and healing effects of the arts out of the arts community and into the scientific realm. To make arts programming a reality in 100% of hospitals in the United States, a new philosophy and approach portraying the therapeutic effects of arts in healthcare should be undertaken by members of the arts community. The future of the arts in healthcare is dependent on proving that art can be a healing agent in the treatment of physical and emotional maladies. 40 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Collaboration between the arts and healthcare communities is necessary in the implementation of scientific and controlled studies that highlight the importance of the arts in the healing process. Studies that support the positive effects of the arts in combination with traditional treatment methods are the next step towards the total integration of the arts in healthcare practices. Arts in Healthcare: Gaining the Support of the Medical Community Illustrating the benefits of arts programming with patient statements and caregiver comments does not prove the positive effects of art to members of the medical community. A paper presented by representatives of the Center for Health Design in 1995 reviewed several medical databases and found “medical literature shows little controlled research supporting the benefits of art in the healthcare environment”41, making implementation of arts programs difficult in a setting that places great weight on scientific proof. The creation of arts programs that offer opportunities for controlled study are necessary for future inclusion of art in medicine. Existing arts programs offer the first steps towards scientific research in regards to the measurable benefits of the arts in the healing process but total integration of science and art has to be taught at the base level, in medical schools and nursing programs. Returning back to the time of Hippocrates when patients 4 1 H.R. Rubin and A.C. Owens “A Concept Paper to Develop a Research Agenda to Determine the Effects of the Healthcare Environment on Patient’s Health Outcomes” paper, The Center for Health Design, 1995. 41 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. were treated with a combination of art and medicine, modern medical school curricula needs to integrate the arts back into medicine. Teaching future caregivers the importance of treating patients with all available resources will increase demand and need for arts programs in medical facilities. How to Proceed: Ideas for the Integration of the Arts in Healthcare The creation of arts programs requires the formation of an administrative group with an interest and knowledge of the importance of arts in healing along with a supporting body from within the medical facility. These supporting parties may include the hospital board of directors, patient advocacy groups, research programs or members of the arts community. Grant programs, volunteer organizations, arts groups like the Americans for the Arts and associations like the SAH provide outside support for program creation, funding and staffing. In addition to providing programs with information and financial support, groups like the SAH are leading the way towards legitimizing the field of arts in healthcare by conducting expansive studies regarding the current state of arts programming in hospitals. Although these surveys are not part of the controlled data collection recommended for the furthering of arts in healthcare, they help administrators learn ways of utilizing available resources and gain insight into various forms of programming that may be applicable to their facility. 42 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. How to Proceed: Evaluating Resources To enact arts programming, an assessment of available resources must be undertaken by interested parties as well as a list of resources needed to meet project goals. Goals should be developed along with resource evaluation and should be used as a guide to target specific resources. Existing resources may include: spaces of opportunity within a facility, funding, supplies, existing collections, administrative support, local community members, social organizations, area arts professionals, volunteers and audience members. Each resource must be carefully evaluated in terms of perceived support level, clearly setting parameters for what may be expected from each. After these evaluations are made, it is possible to identify areas that may require outside support and define where efforts should be concentrated in order to obtain necessary resources. A thorough evaluation of existing art programming should also be conducted and should include all active and passive programming that have existed in the past and those that exist currently at the facility in question. This program review should also include musical performances, volunteer projects and art collections by acquisition or donation. 43 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. How to Proceed: Setting Program Goals To create a successful program a reasonable, realistic set of goals must be developed. Goals should be specific but open, allowing programs the ability to grow over time and introduce different approaches without requiring creation of a new program. Due to the subjective nature of the benefits of arts programming within hospitals, current examples of program goals appear idealistic and rooted in unquantifiable statements. The Alberta Foundation for the Arts, Friends of University Hospitals which runs art programming for Edmonton Hospital describes their program goals as follows: To allow patients and their families to express fears and hopes with regard to the patients’ health and recovery. To share positive reflections, memories and experiences that encourages patients and their families. To provide a focus other than a patient’s pain or distress. To give patients the opportunity to make choices and be independent. To create a positive experience for patient’s and their families to leave the hospital with. 2 A thoughtful and obtainable set of goals whose benefit may not be quantifiable should be placed in a scientific context in order to remain pertinent to possible patrons and members of the medical community. It is clear that there is a need for controlled studies observing the positive effects of art, but many studies regarding the effects of mental, visual and auditory stimulation in regards to the improved health and healing time of patients exist. If program goals are supported by conclusive scientific evidence, more hospitals would work to include the arts in patient care. Using existing 4 2 Artists on the Wards (Alberta, Canada: Alberta Foundation for the Arts, Friends of University Hospitals, 2004). 44 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. programs to support the creation of new arts programming is an effective way to foster interest and gain support. Despite lack of conclusive proof and scientific data, programs that have utilized their resources and successfully brought art into medical facilities make strong cases for additional programming. Program goals must be specific to the audience being served. Programming should be chosen by evaluating which type of program will have the greatest positive benefit to those being served. In larger facilities programs should be chosen based on the audience base including: specificity of patient type and illness, duration of patient stay, location of public and semi-private spaces and accessibility to these spaces. Special consideration should be paid to the wide range of abilities, types and needs of patients. In smaller facilities that treat fewer patients with similar levels of ability, programs can be more specific to individual needs and have a greater focus on addressing certain illnesses. How to Proceed: Choosing the Right Program Large medical facilities often have greater financial and volunteer resources than smaller specialized facilities conversely they have the difficult task of creating programming that is broader in audience scope, requires little audience interaction and can be effective regardless of the duration of a patient’s stay and does not impact public spaces in a negative 45 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. way by effecting space efficiency. In these facilities programs with less interaction that happen on a more frequent basis would have the greatest positive impact. Regularly scheduled performances and spaces open to performance-based community groups should be built into larger facility programming in an effort to gain community support as well as add a sense of regularity to patients’ daily routine. In the public spaces of existing hospitals, performance and passive art programs can be easily implemented with minimal effort and marginal cost. The addition of live music to a patient waiting area or visitor lobby can have a significant effect on reducing anxiety level and creating a more pleasant atmosphere. Volunteer musicians can perform in these public spaces, instantly bringing the therapeutic effects of music to the entire facility. In medical facilities that have an existing passive art program in the form of interior decor, it is possible to reinterpret an existing collection by soliciting donations of work from community members in an effort to begin a revolving collection that generates continued interest from staff and long term patients. How to Proceed: Community involvement and Support In places where universities and schools are part of the surrounding community, students should be encouraged to participate in arts programs in local medical facilities. Students make up a valuable pool of perspective 46 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. volunteers for arts programming. Hospital and school administrators should focus on creating programs that allow students to act as volunteers and performers either as an established class for credit or as a requirement for graduation. Youth involvement is a great opportunity for students to showcase their abilities, practice their talent and affect their community in a positive manner while gaining important experiences that may shape their life in the future. The inclusion of student art shows in the hospital gallery exhibit schedules helps to build community support and encourage the constructive work of local youth. Creating special opportunities for students at an early age allows the hospital to make meaningful connections with participants which may foster future involvement as students grow older, broadening the prospects for future volunteers. Local arts communities, clubs and organizations are another source of possible volunteers. Appealing to community members that already have a strong interest in the arts and have experience in the a variety of artistic mediums offers a creative base for both planning and implementation of arts programming. Inviting local artists to exhibit their work in the hospital gallery or throughout the publicly accessible areas of the medical facility gives artists the opportunity to connect with the hospital and its users. Programs that require active artist participation can be an enjoyable and creative experience for local artists and the patients they engage with. Identifying existing groups that offer a solid volunteer base is helpful in the planning stages of art programming as well as in program implementation. Allowing 47 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. interested groups to become involved in the early stages of a program gives individuals a sense of duty, responsibility and authority throughout the duration of a program. Active art programming or art making requires more fastidious planning, coordination, timing and volunteers than passive and performance art. Programs must invite involvement by the audience but must not require excessive participation or activity which some patients may not be capable of. Art making that requires volunteers and active participants must have a clear goal that is achievable in a limited amount of time. In children’s hospitals, the goal of an art exercise may be to help a child personalize their space or create an enduring item that allows them to imagine the future. Programs targeting older patients may focus on creating art as a positive distraction from painful treatments or as an outlet for emotional stress and tension. Active programming requires consideration regarding: what will be made, what the function of that item will be, where and how these items will be displayed, what things are necessary to create items, what is the estimated time needed to create an item and what level of physical and mental ability are required by the participant to create this item. Special attention should be paid to the way in which items are to be displayed, whether in public places or in the privacy of a patient room. Early decisions regarding the placement of pieces can help determine the type of objects made, the materials used and the size of the items. Sensitivity should be given to the residual effects of tacking art to patient room walls 48 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. versus the use of magnetic services. Tacks leave behind holes that remind current patients of their own temporary stay both in the hospital and in life. Two-dimensional pieces that are displayed in public areas must be made of durable material and must not contain any items that may cause allergic reactions like fabrics or dried flowers. If an item is three-dimensional it must be a manageable size and not become an obstacle in a patient room. Projects that aim at sharing feelings and concerns should be placed in areas where other patients can experience them. This allows the art to function actively and passively. Art that is made by medical staff should be displayed in public spaces where patients can gain a greater understanding of their caregivers. How to Proceed: Tailoring Programs to Users Programs that actively engage patients should have different goals than those geared towards family members, volunteers and medical staff. The needs of these groups are varied thus programming must specifically address the concerns of each. Art programming which is integrated into already existing obligations of medical staff like weekly staff meetings, seminars and required retreats creates a built-in audience that may have similar needs which can be addressed in previously scheduled situations. The addition of art making into preexisting programs enhances shared experiences and gives medical staff the opportunity to interact in a dynamic 49 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. manner with each other and with program leaders. Designating a set time period for creative art making activities allows hospital staff the opportunity to coup with emotional stresses that they would otherwise not address during their day. By engaging in creative activities, care givers are “resting the part of [their] brain that focuses on problem solving...when [they] come back to the task at hand, [they] perform better,” states Elaine Sims, the gifts of art director for UMHS.4 3 Assimilating active arts into everyday life can help caregivers function at a higher level. Doctors, nurses and staff should be encouraged to share their respective talents in an environment that fosters integration of mind and body in the healing process. The emotions experienced by the family members of patients are a complex conglomeration of several feelings which often include: fear, guilt and responsibility. Active art programming that allows family members to voice concerns and share their feelings can help them deal with negative situations in a healthful way and also allow them to be more emotionally available for their loved one. Specialized activities that clearly define the user also allow for the creation of relationships between individuals that have similar experiences. These interactions can lead to greater relationships that help both parties deal with their individual situations. Allotting family members personal time in the form of art programming facilitates individual expression of feelings and signals the importance of emotional well-being of both family members and patients throughout the treatment process. In children’s hospitals, siblings of young patients may 43Wikoff, 6. 50 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. require greater amounts of attention than in other medical situations due to the focus on their ill brother or sister. Art programs that pay particular attention to siblings of ill patients should be implemented in children’s hospitals and medical facilities that treat younger patients. How to Proceed: Creating Quantifiable Results The arts and medical communities must work together in an effort to reintroduce the arts back into patient treatment. To gain support for these programs it is necessary for the arts community to speak the language of medicine, business and design. The future of the arts in healthcare is predicated on the collection of scientific data that proves that the arts function in a therapeutic agent in the healing process. All participants in art programs should be given questionnaires regarding positive and negative reactions elicited by a specific art program. Evaluating a participants’ emotional state before and after engaging in art activities can help quantify emotional benefits. First hand statements on the feelings that art making causes and the minimizing effects that it has on tension and stress levels helps link art to emotional responses. There is a fundamental need for scientific studies that detail the health effects of arts programming on involuntary patient responses to be conducted in an effort to prove the benefits of art in healthcare. In many cases, these studies can be easily integrated into patient care by noting a 51 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. patient’s blood pressure prior to programming, during the activity and at the completion of the activity. It is common practice in hospitals to regularly record patient vital signs, doing so at points that correspond to art programs could supply the data needed to connect the positive benefits of the arts within healthcare. Measurements of blood pressure, heart rate and needed medication levels should be taken in fixed intervals after the completion of the activity to access the long-term effects of art making on patient health. Data that supports the positive effects of the arts in healthcare could be easily obtained by using methods already implemented by the medical facilities. Arts professionals working in combination with members of the medical community could easily implement controlled scientific studies using existing programs as testing grounds. The simplicity in which these studies could be conducted in proper hospital environments adds to the glaring lack of scientific evidence which links the positive effects of arts on physical and emotional health. Questionnaires, interviews and vital sign measurements should be utilized as proof of arts healing abilities. Gathering data from similar arts programs throughout the world would create a large enough sample base that would give studies legitimacy. 52 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. How to Proceed: The Future of the Arts in Healthcare Hospitals are a unique combination of public, private and commercial enterprises that must be profitable while offering the best in medical care. The services offered and the built environment of most facilities are quite similar leaving hospital administrators wondering how to set themselves apart in the medical field and have broader appeal to the medical consumer. The integration of art within medical treatment and throughout the built environment can act as an amenity that entices perspective medical consumers to choose one facility over the other. Educating medical professionals and consumers on the positive benefits of the arts in healthcare will help to further the relationship between the arts and medicine. Medical consumers who understand the need for holistic treatment and desire a more complete approach to medical care will begin to choose facilities that offer passive and active art as part of the treatment process. Consumers now demand experience in conjunction with services and in the space of the hospital the need for experience can be fulfilled through the arts and art programming.4 4 The movement to support the arts in healthcare is gaining momentum through the efforts of groups like the SAH and pioneering medical facilities that approach health care in a holistic manner. Integrating scientific data collection into arts activities will allow programs to further themselves within the medical field by offering conclusive proof of the positive benefits of the 44 Florida, 168. 53 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. arts on patient well-being. Training future doctors and caregivers on the advantages of complete emotional and physical treatment of patients and the ability of the arts to facilitate patient wellness will create an environment within the healthcare field that embraces art as an effective way to treat the ill. A symbiotic relationship between art and medicine will become the next advancement in the patient treatment. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 54 Bibliography Artists on the Wards. Program Description. Alberta Foundation for the Arts, Friends of University Hospitals. 2004. Boschetti, Joe, ed. Health Spaces: A Pictorial Review. Volumes 1 and 2. Australia: Images Publishing Group Pty Ltd, 2003. Crisp, Barbara. Human Spaces: Life-Enhancing Designs for Healing. Working, and Living. Massachusetts: Rockport Publishers, 1998. De Silvia, Padmasiri. Environmental Philosophy and Ethics in Buddhism.New York: St. Martin’s Press, Inc, 1998. Florida, Richard. The Rise of the Creative Class: and How it’s Transforming Work. Leisure. Community and Everyday Life. New York: Basic Books, 2002. Friedrich, M.J. “The Arts in Healing”. The Journal of American Medical Association. 19 May 1999. Gesler, Wilbert M. Healing Places. Lanham: Rowan & Littlefield Publishers, Inc., 2003. “Gifts of Art Home Program.” University of Michigan Health System. 11 May 2005. <http://www.med.umich.edu/goa/programs.htm> “Hospital Artist-in-Residence Program.” Smith Farm: The Arts in Healing Center. March 2005. <http://www.smithfarm.com/healing.html> Loori, John Daido. ed. The Art of Just Sitting. Boston: Wisdom Publications, 2002. Mehrabian, Albert and James A. Russell. An Approach to Environmental P s v c o Io q v . Massachusetts: The Massachusetts Institute of Technology, 1974. Miller FAIA, Richard L. and Earl S. Swensson, FAIA. Hosotial and Healthcare Facility Design: Second Edition. New York: W.W. Norton & Company, 2002. Monk, Tony. Hospital Builders. Great Britain: Wiley-Academy, 2004. viii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. “Overview of Laws that Help the Uninsured Access Healthcare.” Health Assistance Partnership. 2004. Families USA. 27 January 2004. <http://www.healthassistancepartnership.org/site/PageServer7pagenam e=Uninsuredoverviewlaws> Purves, Geoffrey. Healthy Living Centres. Oxford: Architectural Press, 2002. Rubin, H.R. and A.C. Owens. “A Concept Paper to Develop a Research Agenda to Determine the Effects of the Healthcare Environment on Patient’s Health Outcomes” paper. The Center for Health Design. 1995. Ridenour, Anne. “The Arts in Health Care Settings.” Journal of American Medical Association. 4 February 1998. “Shands Healthcare Projects.” Shands Healthcare. 2004, University of Florida, Gainesville, 17 March 2005, <http://www.shands.org/hopsitals/UF/AIM/projects.htm> Trungpa, Chogyam. Pharma Art. Boston: Shambhala Publications, 1996. Wikoff, Naj. “Cultures of Care: A Study of Arts Programs in U.S. Hospitals.” Monograph: Americans for the Arts. November 2004. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Appendix A Art Programs of Interest The Foundation for Hospital Art http://www.hospitalart.org/index.html The foundation supplies paint-by-numbers kits for murals, ceiling tiles and poster paintings that allow patients and hospital visitors the opportunity to engage in easy art making activities. Dartmouth-Hitchcock Medical Center http://www.dhmc.org The medical center affiliated with nearby Dartmouth University offers several art programs including an artist-in-residence program as well as exhibit space and an extensive art collection donated by hospital patrons. For further information regarding the hospitals arts programming, email volunteer services at elisabeth.w.Qordon@ hitchcock.ora. Children’s Hospital and Health Center of San Diego http://www.chsd.org The facility was one of the recipients of the 2003 Sadler award given by the Society for the Arts in Healthcare for outstanding use of the arts in environment and patient care. Unique design elements and aesthetic details make the medical center less threatening to young patients and their families. El Camino Hospital http://www.elcaminohospital.org The hospital and it’s staff engage in various forms of the arts including: comedy, art making and musical performance. Also, the hospital uses television programming available in patient rooms and staff lounges to create relaxing environments. University of Iowa Health Care http://www.uihealthcare.com Started in 1978, this program is spread throughout seven hospitals affiliated with the University of Iowa. Incorporating passive, active and performance art, the program also includes guided walking tours for staff and visitors of the extensive art collections. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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Asset Metadata

Creator Lee, Cathryn Rachel (author)

Core Title The arts in healthcare: Past, present and future plans for the integration of the arts within medical facilities and treatment practices

Degree Master of Physician Assistant Studies\Master of Public Art Studies

Degree Program Public Art Studies

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Design and Decorative Arts,Fine Arts,health sciences, health care management,OAI-PMH Harvest,sociology, public and social welfare

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-51955

Unique identifier UC11328846

Identifier 1435114.pdf (filename),usctheses-c16-51955 (legacy record id)

Legacy Identifier 1435114.pdf

Dmrecord 51955

Document Type Thesis

Rights Lee, Cathryn Rachel

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA