Hospital healthcare providers have supplemented clinical care with creative arts since the mid-20th century. For example, art and dance therapy have played a supporting role in hospital patient care since the 1930s. Using music to soothe cancer patients during treatment was pioneered at the University of Chicago Hospital as early as 1948. Music was also piped into some hospitals’ surgical suites to calm patients under various forms of spinal, local, or regional anesthesia.1
In recent years, there has been a groundswell of interest in both art therapy and the expressive arts in healthcare, resulting in the proliferation of bedside programs involving not only the visual arts and music, but also dance and creative writing.
According to the Art Therapy Credentials Board, “[A]rt therapy is a human service profession, which utilizes art media, images, the creative art process, and patient/client responses to the created art productions as reflections of an individual’s development, abilities, personality, concerns, and conflicts.”2 Anecdotal evidence has long supported the efficacy of art therapy in treating the chronically ill. But only recently have clinical studies proved that making art and the creative process it involves helps hospitalized patients heal in a quantifiable way.
One such study, conducted among adult cancer inpatients at Chicago’s Northwestern Memorial Hospital, was published in the February Journal of Pain and Symptom Management. That study determined that a series of one-hour art making sessions with a therapist yielded statistically significant decreases in a broad spectrum of symptoms, including pain, fatigue, depression, anxiety, lack of appetite, and shortness of breath. It also helped reduce apprehension, tension, nervousness, and worry. In addition to the quantifiable positive effects of art making, “subjects made numerous anecdotal comments that the art therapy had energized them.”3
But art therapy, administered by a credentialed practitioner with the specific goal of treating emotional and psychological issues associated with illness as a clinical practice, is not the only type of bedside artistic production happening in hospitals. Expressive art making, which falls under the umbrella of the arts in healthcare movement, has gained a significant foothold. In 2002 the National Endowment for the Arts (NEA), which funds arts in healthcare research, issued a call for creative artists not specifically trained as art therapists to play a larger role in patient care.
According to Elizabeth A. Curry, MA, coordinator of the Mayo Clinic Center for Humanities in Medicine, expressive bedside art-making has a different goal than therapy.
“The art therapist is part of the care plan team,” says Curry. “She writes in the charts.” As guided by a creative artist rather than by a therapist, the very experience of making art—rather than the information a finished work of art may furnish the care plan team—is central to the undertaking. It is the artist’s experience with the patient and the patient’s experience with the media that are important—not the end result. Of this model of bedside art making, Curry says, “it has no therapeutic goal other than to relieve stress.” The scope of expressive bedside art creation administered by an arts in healthcare program is potentially much broader than one that is therapy-based and has the potential to reach more patients.
Among studies of a number of arts-in-healthcare programs, the NEA cites the success of Healing Icons, an art-support program for young adult cancer patients age 16 and older.
According to the NEA, “In the program, patients create a three-dimensional mixed-media art piece to convey a unique personal perspective on receiving a diagnosis of cancer and then experiencing treatments.”
The mixed-media piece “provides a way for unstructured expression of feelings and thoughts.”4 The NEA also points to an article published in The Lancet (May 2001) that discussed the creative output of several expressive arts programs implemented in the United Kingdom. In one, comic artists held a series of workshops with young patients at the Great Ormond Street Children’s Hospital. Those workshops resulted in a comic book, HospiTales. Not only did this undertaking produce “interesting therapeutic and creative results” for the participants, the finished HospiTales promoted “a positive view of being in hospital, which makes it seem a less scary place for young patients.”5
Not surprisingly, the number of new arts in healthcare initiatives has continued to grow. For two months, beginning in August, for example, the Mayo Clinic Center for Humanities in Medicine began a pilot program in conjunction with the Rochester Arts Center in Minnesota to bring bedside art making to the Hematology Department. The Hematology Department, in particular, appears to be the ideal place to conduct such a pilot program. “People are stuck in the hospital with a lot of uncertainty, stress, and discomfort,” says Mayo’s Curry. “Making art can give people back a sense of control and relieve some anxiety.”
At the outset, Education Coordinator Michele Heidel of the Rochester Art Center will work with the nursing staff to identify 20 patients who might be interested in participating in what have been termed “art interventions.” Patients will paint and draw with professional artist-educators, who will offer participants a variety of media such as oil pastels, chalk, charcoal, and watercolors in which to work. These materials are chosen not only for their ease of use, but because they are safe, nontoxic, clean, and conform to ASTM Standard D-4236 Practice for Labeling Art Materials for Chronic Health Hazards. They also carry No-Odor labeling.
Prior to engaging with patients, artist-educators receive training in infection control, including OSHA Bloodborne Pathogen training and instruction in disinfecting equipment, art supplies, and work surfaces. They are also briefed on HIPAA compliance. Attendance at the Arts in Healthcare Summer Intensive Training at the University of Florida (Gainesville) and a site visit to the Mayo Clinic Jacksonville Arts at the Bedside program completes their orientation. Though they are not officially part of the care plan team, artist-educators also attend hematology inpatient rounds.
Each of the 20 patients chosen to participate in the pilot study will be assessed both before and after working with the educator-artist by means of questionnaires, as well as by Visual Analogue Scales to see how a single art intervention affects anxiety, discomfort, and stress. Ultimately, the purpose of this benefactor-funded pilot program is to provide quantifiable evidence for the efficacy of bedside art making.
According to Curry, the Center for Humanities in Medicine would like to grow the program significantly, eventually offering patients a menu of choices of creative arts in which to participate. This menu would also include music, dance, and creative writing. “It’s a big goal for the future,” says Curry.
For patients participating in Mayo’s pilot study, talent or artistic ability is not an issue. According to Curry, the program is process oriented rather than project oriented. Unlike the HospiTales project, the pilot study focuses on the relationship among the patient, the artist, and the media rather than on creating a finished piece. The Mayo Clinic’s Center for Humanities in Medicine has no specific plans either to exhibit or publish any of the artistic productions created by study participants.
“There will be a lot of amazing art and amazing writing,” says Curry. But the legal technicalities involved in publishing or mounting an exhibition of art work, including the necessity of having patients give permission and sign release forms, may simply be too daunting for those involved. Curry does not, however, rule out an exhibit or a book of patient work in the future.
In conjunction with Arizona State University, the Mayo Clinic’s Scottsdale center has also introduced several arts programs, including music at the bedside in Palliative Care, and a bedside creative writing program. During sessions that last about 45 minutes and center around the one-on-one interaction between the artist and the patient, patients narrate their personal stories, from which participating writers generate original works on hand-made paper. The finished pieces are then returned to the patient-narrators. These works have proved extremely meaningful not only to the people whose stories they tell, but to the storytellers’ families as well.
Based on its own successful programs, which include bedside art making, the Integrative Medicine department at Hartford Hospital in Connecticut has published an on-line Program Development Manual, “Building Bridges,” which provides “a blueprint for spanning the not-yet-connected terrain of Conventional Medicine and Complementary and Alternative Medicine,”6 Indeed, in addition to sections dealing such practices as massage therapy, acupuncture, Reiki, and Tai Chi, as well as guided imagery, “a mind-body intervention that focuses the imagination and the five senses to create soothing and relaxing images,”7 “Building Bridges” includes a chapter on “Creating an Art for Healing Program,” written by Diana S. Boehnert, artist-in-residence and coordinator of the Art for Healing Program.
According to Boehnert, art making as part of a larger Integrative Medicine program “creates a better quality of life for people with chronic illness.” Hartford Hospital’s program, which she administers, employs both clinically trained art therapy interns and volunteers, whose work follows the expressive bedside art making model. As such, the Art for Healing section of “Building Bridges” deals extensively with the training and preparation of artists. According to the manual, candidates without previous experience working in a hospital setting benefit from partnering with a clinical staff member as part of the training process. In addition to the requisite “orientation to patient care area with review of patient care environment, equipment, safety issues, and the needs of the specific patent population,” “Building Bridges” suggests that trainees also engage in “mock art sessions with a preceptor or mentor.”8 While it is also recommended that candidates have some background in the expressive arts, formal art training is not an absolute requirement. In reality, says Boehnert, “It doesn’t matter how much [formal art] training they have, the patient does the work.”
Unlike the Mayo Clinic’s pilot study, Hartford Hospital’s program is project oriented. “The project is the impetus that gets the patient going,” says Boehnert. “Adults aren’t willing to play without a purpose. They just want a little direction.”
For the most part, individual projects are small. They range from mandalas (circular designs generally associated with Buddhist and Hindu practice) to cards for family members. “Intuition,” explains Boehnert, “tells the volunteers what will work best with a patient.”
Hartford Hospital’s Arts for Healing is not limited to patients in a single department. Boehnert, whose previous experience with arts in healthcare included plaster cast mask-making with survivors of domestic violence, began working with rehab patients and extended the program to include dialysis patients. It’s now available in various departments throughout the hospital. Some of the work created by Arts for Healing participants in the Art for Healing program is on display in a small gallery in the hospital.
According to Boehnert, patient response to arts initiatives like the ones advocated in “Building Bridges” has been overwhelmingly positive. As an example, she cites a heart transplant patient who was introduced to the expressive arts during his six-week stay at Hartford Hospital. Before he was discharged, he created his own little gallery in his room. A patient being treated for leukemia also created an impressive body of work, giving pieces away to cheer up fellow patients who were not having good days. Staff, too, says Boehnert, benefit from Art for Healing: “My volunteers also go home better than when they came.”
Since 1991, the Society for the Arts in Healthcare (SAH) has provided support for programs such as the ones at Hartford Hospital and the Mayo Clinic, as well as others like the Artists in Residence program at Florida’s Shands HealthCare hospitals, which offers patients a variety of bedside art making activities. Examples include Art Infusion, a multi-media program for adults on chemotherapy, creative arts for pediatric inpatients, and (like Mayo Scottsdale) an oral history program which seeks to transcribe patients’ personal stories.
“In a lot of places, funding is a struggle,” explains Curry. To help secure funding for arts in healthcare programs, the SAH provides grant opportunities, like the SAH/Johnson & Johnson Partnership to Promote Arts and Healing and SAH Consulting Grants, as well as several awards.
In April, the SAH hosted its 15th international arts in healthcare conference in Chicago, the topic of which was “Vision + Voice—Charting the Course of Arts, Health and Medicine.” The conference urged attendees to “focus (their) vision for the future.”9 Given ever-increasing interest in integrating the arts into healthcare—especially inpatient care—be it by means of the clinical practice of art therapy or by expressive, creative arts programs, the future of such programs seems bright. As Dana Gioia, chair of the NEA, says: “The arts have an extraordinary ability to enhance our lives, to help us heal, and to bring us comfort in times of great stress. We must reconnect the arts with the actual human existence that Americans lead, the journeys we take in life, which lead us through hospitals, to hospices, to the end of life.”10 TH
Roberta Newman is based in Brooklyn, N.Y.
- NEA News Room: Arts in Healthcare Research. Available at: http://arts.endow.gov/news/news03/AIHResearch.html. Last accessed June 16, 2006.
- Art Therapy Credentials Board, “What is Art Therapy?” Available at: www.atcb.org. Last accessed June 16, 2006.
- Nainis N, Paice J, Ratner J. Relieving symptoms in cancer: innovative use of art therapy. J Pain Symptom Manage. 2006 Feb;31(2):162-169.
- Arts in Healthcare Research. National Endowment For the Arts New Room. Available at: http://arts.endow.gov/news/news03/AIHResearch.html. Last accessed June 12, 2006.
- Foster H. Medical settings foster the creation of art. Lancet. 2001;357(9268):1627.
- Foreword. “Building Bridges.” Available at: www.harthosp.org/IntMed/manual/foreword.asp. Last accessed June 18, 2006.
- Guided Imagery. “Building Bridges.” Available at www.harthosp.org/IntMed/manual/guidedimagery.asp. Last accessed June 18, 2006.
- Creating an Art for Healing Program: Training. “Building Bridges.” Available at: www.harthosp.org/IntMed/manual/art.asp. Last accessed June 18, 2006.
- Vision +Voice—Charting the Course of Arts, Health and Medicine Society for the Arts in Healthcare 15th Annual International Conference Program. Available at: www.thesah.org/doc/FINAL%20program.pdf. Last accessed June 18, 2006.
- Society for the Arts in Healthcare Fact Sheet. Available at: www.thesah.org. Last accessed June 19, 2006.