Category Archives: Creative Interventions for Patients

Turning Swords to Paintbrushes, and Warriors to Painters…

          paintbrushes1

On October 12, 2009, the New York Times published an article titled “Turning Swords to Pens, and Warriors to Writers.”  The story summarizes an effort organized by the Writers Guild of America in mentoring wounded U.S. military veterans to write their stories.  The writing workshop received support from the Wounded Warrior Project, and the National Endowment for the Arts Operation Homecoming.  Below is a summary of the article, some information on traumatic brain injury (TBI),traumatic brain injury and my recommendation to offer painting  and the visual arts as a healing modality for self-expression of the horrors and psychic wounds of war.

Here’s are few veterans’ responses on the writing workshop…

  • One veteran struggled to find what exactly it was that he wanted to say.
  • Another said “…there’s something in my heart…I feel like it’s a calling to write.”
  • Yet, another veteran’s real reason for attending the writing workshop was to sharpen her writing skills for a historical compilation of her family history, and the role America plays in their lives.

Writing offers veterans an avenue for expressing personal stories and experiences of combat, and is a fine medium for those capable and desiring to write.  However,  for veterans with traumatic brain severe-nerve-damageinjuries, writing may not be the best arts modality to offer due to nerve damage or loss of neural connections within the brain. This loss of neural connections may lead to many of the symptoms associated with brain injuries. Depending on the location,  severity, and rapidness of treatment for traumatic brain injuries, there may be difficulties with the following (in relationship to writing).

  • Inability to focus on task
  • Difficulty with problem solving
  • Inability to express language (Broca’s Aphasia)
  • Slower thinking
  • Inability to attend to more than one object at a time
  • Inability to name an object (Anomia)
  • Inability to locate the words for writing (Agraphia)
  • Problems with reading (Alexia)
  • Inability to focus visual attention
  • Difficulties with eye and hand coordination

 (Source: Brain Injury Association of America www.biasusa.org)

To learn more about the other myriad symptoms associated with traumatic brain injuries in the military, visit the link below – DHCC.

According to DHCC  (Deployment Health Clinical Center) , the website states that early mild TBI symptoms may appear subtle, but they can lead to significant, life-long impairment in an individual’s ability to function physically, cognitively and emotionally.  Btw, DHCC is located at Walter Reed Army Medical Center in Washington, DC.

In a New England Journal of Medicine article on TBI in the military, it  Iraq-Soldiers-PTSD15dec04reported 56%  of those diagnosed with TBI are considered moderate or severe, and 44% mildAlso, some symptoms of TBI overlap with those of post-traumatic stress disorder (PSTD).  Those in the military are usually young and healthy, and have a good chance to recover from TBI.  However, they have been hurt in terrible ways which may complicate and affect their recovery outcome. (1)

Use paintbrushes rather than pens…

Given the cognitive, visual and motor coordination problems veterans paintbrushesexperience as a result of TBI, writing may not be the best avenue for self-expression.  Painting (and the visual arts) as a creative intervention is a much better choice of medium.  Why?

  • With writing, there is a tendency for  internal editing and censoring of the written word, and this is by those of us without brain injuries!  Imagine the frusration of veterans suffering from mild to moderate  symptoms of  TBI.
  • Writing requires fine eye – hand coordination. Painting, on the other hand,  involves more gross motor coordination.
  • Painting requires less cognitive and visual perfection or acuity.  For example, Claude Monet painted despite his progressing blindness.

Claude Monet water lilies

(Claude Monet, water lilies, 1840-1926)

  • Painting utilizes imagery rather than words to express psychological and emotional states.
  • In painting, there is no right or wrong methods, techniques or colors to convey meaning and thoughts.  Writing requires concentrated effort, exactness and command of the written language.
  • Paintbrush handles can be adapted for those unable to hold thin paintbrushes.
  • There is less internal editing with painting.

Email me if you want the bibliography.

Try this simple Creative Intervention…

music-notes1I’d like to introduce and describe a short and simple Creative Intervention to try on your own.  I developed this CI (Creative Intervention) for use in my Creativity Workshops. 

The goal is to visualize the music you hear and transfer these images onto paper.  It will take about 10 minutes to complete the music-notes1exercise, but may be longer depending on how much time is devoted to your drawing; the musical piece is 5:25 minutes long.

But first, read the short list of instructions and then go for it! 

A few Instructions:

1. The music selected for this particular Creative Intervention is Beethoven’s Pathetique Movement 2 by Freddy Kempf.  I chose Freddy beethovenKempf’s version over other artists for his expressiveness and sensitivity in interpeting this piece.

The link below is to a youtube video.  The goal is to listen with your eyes closed. No peeking to watch Freddy during this exercise; you can watch him later!

Note: It’s important to be in an quiet environment for you to benefit from this exercise.  So, close your office door or wait for better time.

2. Gather your supplies: white paper and drawing/coloring tools in different colors (crayons, colored pencils or markers).  Anything you crayonscan draw with is fine, but make sure you have different colors.

3. Listen to the selected piece by clicking on the link. Remember- keep your eyes closed during the entire musical piece.  The goal is to shut out outside visual images and noises, and focus on you.

While you’re listening, picture how the music would look if you could see it.  What are the colors and shapes you see?  Are there lines?  Is it abstract?  What are the rhythms, the melodies and mood(s) you see?  How does the music make you feel?  Are there words or just colors or images? Don’t worry about drawing anything you may not recognize – that’s not important to this exercise.  Remember, there is no right or wrong way of doing this exercise - just your way.

music-notes1

      Are you ready to begin?

Increase the volume on your computer to mid-way – Beethoven’s Pathetique Movement 2 is very soft in certain sections.

CLOSE YOUR EYES and listen for the entire duration.  Click the youtube link below and listen to Freddy Kempf’s version Beethoven’s of Pathetique Movement 2.   According to music interpretation,  Pathetique in its entirety is not a sad song piece.   Beethoven wrote this when he found out he was losing his hearing. The first movement is depicting the rage and sorrow he felt. The  second movement (the youtube video below) is depicting the comfort he receives.  The third movement is almost a testament of joy.


Now, draw what you ‘saw’ when your eyes were closed.  When you’re finished, look at your drawing for a few minutes.  Don’t be critical about it – it is what it is.  Try this exercise with your favorite musical pieces – rock, alternative, classical, pop, etc.  Compare the 2nd, 3rd drawing with the first.

Creative Interventions are not just for patients…

Creative Interventions should be experienced by all healthcare professionals, not just patients.  Who will benefit?  Nurses, doctors, ancillary nursing personnel, social workers, OT, PT, healthcare managers and executive staff, and academicians.  By experiencing and expanding your own definition of creativity, it will ultimately benefit your patients and your daily interactions with others.

 mhand_stem-cell-garden_sm(stem cell garden, Marti Hand 2008)

Concierge services in hospitals…

Back in February 2009, I wrote a post titled ‘Creative Interventions as Patienttinybrain Amenities in Hospitals’ based on an article in BusinessWeek (Feb. 16, 2009).  To summarize, the article cited a RAND marketing study indicating concierge/hospitality services as more desireable than high-quality patient care.  If this is any indication how consumers think and choose their healthcare institutions based only on plush accomodations versus low mortality (death) rates to recover from mild to life-threatening conditions, we are becoming a nation of non-thinkers.  Concierge services does NOT equal high-quality patient care!

As an advocate for integrating creativity and the creative process in healthcare, I believe creating environments conducive to the healing process is a step in the right direction.  But concierge services?  How do these services help patients and monet_givernyfamilies heal?  Are there any long-term benefits of  hotel-like services for patients?  Or have hospitals strayed from their original missions and visions?  I believe the latter may be true, i.e., hospitals have lost their original vision of healing the sick in an attempt to gain market share, but at least we’ll be able to attend a cooking class at Henry Ford West Bloomfield Hospital.

                                          (Garden at Giverny, 1900 Claude Monet)

And this trend of hospitals offering concierge services termed ‘amentities’ is growing.  In July 2008, USA News had an article titled, “Who Says a Hospital Stay Can’t Be Fun?”  It shed light on the growing movement of hospitals to function more like hotels by offering amenities, such as gourmet dining, fine art, field trips, cooking and gardening classes, afternoon tea service, Wi-Fi connection, and much, much more!

Here’s a few examples of amentities offerings at some hospitals across the US: Century City Doctors Hospital in Los Angelos’ markets it’s menu created by Wolfgang Puck…installed flat-screen TVs in all rooms…M.D. Anderson Cancer Center offers patients field trips to local museums…cooking classes at Henry Ford West Bloomfield Hospital.  I wonder if patients attending a cooking class or taking a field trip actually need to be in the hospital.  WHO is paying for all this luxury?

music-notes1

Let’s offer Creative Interventions as Patient Amenities.  At least, there is scientific data to support the benefits of engaging in the creative process and the arts.  Read ‘The Science Supporting Creativity in Healthcare’ under TOPICS on the left side.

 

Creative Interventions = Patient Amenities

Creative Interventions = Smart Marketing Strategy

Creative Interventions = Cost-Effective Treatment Modalities

catherinelindaMHand_nurses fingerprint_blue sm

 Activate the body’s self-healing properties by exploring the  relationship between art making and self-care with

Creative Interventions in Healthcare:

  • Art-making
  • Writing
  • Music
  • Dance
  • Humor
  • Laughter clubs
  • Art exhibits with artwork created by patients, families, professional staff
  • Indoor and outdoor healing gardens
  • Art at the bedside
  • Creative interventions for healthcare professionals
  • Integrative medicine modalities

Blair Sadler, former President & CEO of Rady Children’s Hospital & Health Center (San Diego) and strong supporter of the arts in healthcare said the following…

“The arts optimize patient care and can create a strategic business advantage by differentiating themselves from competitors, and effectively garner support for starting and maintaining art programs.”

waterfall

Nature…the ultimate healer.

Drawing as a diagnostic tool in lupus patients

Here’s another interesting article on the use of drawing as a diagnostic tool in Med-U-Gdanskassessing people diagnosed with lupus, aka, systemic lupus erythematosus (SLE).   A qualitative study was conducted at the Medical University of Gdansk, Poland with 2 main goals.  First, to examine the ways illness is perceived and experienced by patients with lupus and second, to assess the use of drawing as as a diagnostic tool. 

But first, let’s look at some facts about lupus…

What is lupus or systemic lupus erythematosus (SLE)?

According to the Lupus Foundation in Washington, D.C.,  “lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, kidneys”, heart, blood vessels, lungs and brain. 

Lupus, like rheumatoid arthritis, is an autoimmunie disorder where the immune system cannot tell the difference butterfly_lupusbetween foreign substances and its own cells and tissues.  The immune system is designed to attack foreign substances in the body, but in lupus, something goes wrong with the immune system and begins to make antibodies that attack healthy cells and tissues causing inflammation, pain and damage to the body. 

  • The primary feature of lupus is inflammation and is characterized by pain, heat, redness, swelling and loss of function, either on the inside or on the outside of the body (or both).
  • For most people, lupus is a mild disease ususally affecting a few organs.  But, for others, it may cause serious and even life-threatening problems.
  • Lupus affects more than 1.5 million Americans, and at least five million persons worldwide. 
  • There is no known cause, but is believed to be triggered by a number of factors, such as environment and genetics.  Environmental factors triggering the disease are infections, antibiotics (sulfa and penicillin groups), UV light, certain drugs, hormones and extreme stress.
  • Scientists believe there may be a genetic predisposition to the disease, as lupus is known to occur within families. But, there is no known gene or genes which are thought to cause the illness.
  • More than 16,000 Americans develop lupus each year.
  • Lupus is more prevalent in women of African-American, Hispanic, Asian and Native American culturesmulticultural
  • Symptoms may be sporadic. The times when a person is having symptoms are called flares, which can range from mild to severe. New symptoms may appear at any time.
  • Common symptoms include: pain or swelling in joints,  muscle pain, fever sad-sunwith no known cause, red rashes on the face, chest pain when taking deep breaths, hair loss, pale or purple fingers or toes, sensitivity to the sun, swelling in legs or around the eyes, ulcers in the mouth, swollen glands, and feeling fatigued.

(Sources: Lupus Foundation, NAIMS/NIH)

 And now, back to the study on the use of drawing as a perceptual and diagnostic tool in assessing persons with lupus.  To summarize, the key points are below:

  1. Patients’ perceptions of their disease influences emotions, behavior, health care needs and expectations, and these perceptions results in differences in attitude, coping and functioning among patients with similiar clincial symptoms.  Which means patients’ personal views and attitudes of their disease differ despite similar clinical symptoms and diagnosis, and are important in promoting self-care and self-responsibility.
  2. Perceptions of illness can be a better indicator of future physical damage to the body and health condition than clincial signs and symptoms.
  3. Currently, the primary draw_crayonassessment tool in measuring illness perception is verbal communication.  By drawing their disease,  it had patients think about their disease in a different way, and produced “incredibly tangible” insight of the impact of lupus to the patients themselves and healthcare professionals.
  4. The study concludes there are a variety of symptoms and different clincial pictures based on the drawings, rather than ‘general’ symptoms experienced by patients with the same diagnosis.
  5. Drawing as a diagnostic tool can help healthcare professionals avoid forming and categorizing patient symptoms with the same diagnosis.

Asking patients to draw their disease provides a wealth of information  they may not be able to express in words.  The old phrase ‘a picture is worth a thousand words’ definitely applies here.  This is helpful in developing more individualized treatment plans that take patients’ perceptions and attitudes of their disease into account.  By actively engaging patients’ to take interest in their own treatment plans, the tenets of self-care and self-responsibility are more readily accepted by patients, thus leading to better patient outcomes. 

Drawing provides valuable sensory and cognitive information to health professionals in understanding and treating patients with different disease conditions, not just lupus.

Note: email me if you want the bibliography

Below is a favorite Rumi quote…

rumi

Have you figured out what your particular work is?

Effects of Art in Lowering Pain Levels

Since starting the ‘Creativity in Healthcare’ blog back in October 2008, the number of readers/visitors has grown exponentially, averaging 150 per day!  Thanks everyone for visiting and reading.  Come back often! :) 

 

Now, onto integrating Creativity in Healthcare…

Effects of Art in Lowering Pain Levels

The power of art to heal emotional, spiritual and psychic wounds is well known, but could looking at art considered beautiful or magnificent have the same effect on physical pain?  Researchers at the University of Bari in Italy also wondered this and decided to investigate.mhand-crystallized-testosterone-estrogen-sm

Research was coordinated by the neurological and psychiatric sciences department at the University of Bari, Italy.  Principle investigator, Dr Marinade Tommaso, concludes that looking at paintings identified as ‘beautiful’ may lower pain levels in hospital patients, than those looking at bare walls or plain pictures in disrepair.                                           (crystallized testosterone & estrogen, Marti Hand)

Lead researcher and neurologist, Dr Marina de Tommaso and assistants asked 24 healthy adults (12 women & 12 men) to select 20 paintings they considered most ugly, and most beautiful from a selection of 300 starry-night-van-goghworks by artists such as Leonardo da Vinci, Picasso and Botticelli from an online art website.

They were then asked to contemplate either the beautiful paintings, ugly paintings, or a blank panel while the team administered short laser pulses on their hands causing a pricking sensation.  Below are the conclusions made by the researchers of the study:

  • The subjects rated the pain as being 1/3 less intense while viewing the ‘beautiful’ paintings compared with the pain levels experienced while viewing paintings they considered ugly or the blank panel.
  • Brain wave activity showed a reduced response to the pain when birth-of-venus-botticellithe subject looked at positive or beautiful paintings, such as Starry Night by Van Gogh and The Birth of Venus by Botticelli.  Artwork considered ugly or plain  included art by Pablo Picasso, Fernando Botero and Antonio Bueno.  Remember, the subjects selected the art they considered beautiful, ugly or uncomely at the beginning of the study.
  • Dr. Tommaso states, “Beauty obviously offers a distraction that picassougly things do not. But at least there is no suggestion that ugly surroundings make the pain worse.” By viewing aesthetically pleasing artwork, pain levels may be reduced or changed at the cortical level in the brain.
  • *Brain scans showed “a clear inhibition of the P2 wave amplitude, localised in the anterior cingulate cortex”.  (The anterior cingulate cortex (ACC) plays a role in regulating blood pressure and heart rate, cognitive functions such as anticipating reward, decision-making, empathy and emotion).

Sources: 1)de Tommaso M, Sardaro M, Livrea P.  Aesthetic value of paintings affects pain thresholds. Consciousness and Cognition Dec 2008; 17(4): 1152-1162. 2) University World News, 3) New Scientist 

 

Activate the body’s self-healing properties by exploring the  relationship between art making and self-care with

Creative Interventions in Healthcare:

  • Art-making
  • Writing
  • Music
  • Dance
  • Humor
  • Laughter clubs
  • Art exhibits with artwork created by patients, families, professional staff
  • Indoor and outdoor gardens
  • Art at the bedside
  • Creative interventions for healthcare professionals
  • Integrative medicine modalities
  • Limitless possibilities

Below are 2 paintings created by 2 participants in a Creativity Workshop for People with Cancer & Families.  What’s more interesting than the fact of it being their first time painting are their stories behind the paintings.

darlene2

cw_hope-lodge-portrait5

Listening to Music: another Creative Intervention for patients

I think music in itself is healing. It’s an explosive expression of humanity. It’s something we are all touched by. No matter what culture we’re from, everyone loves music.” ~billy joel

music-notes1music-notes1music-notes1

Like art, many believe music to be a universal language…that there is no need for words.  To the listener, the effects of music is both simultaneously individual and universal, i.e., communing with oneself and the larger commUNITY.

Music can induce both physiological and psychological responses in you.  The use of music to promote health and well-being is referred to by many as music therapy.  However, I prefer the term ‘Creative Intervention or Music Intervention,’ over music therapy.  Why?  Because, the word ‘therapy’ is most often associated with the behavioral music-notes6health field where healthcare professionals have expertise in the art of helping a patient psychologically.   A study of an arts support program concluded the word ‘therapy’ may be threatening to patients because most do not view themselves as needing ‘therapy.’ (1)   But, I’m not going to quibble about choosing a couple words; the most important thing is implementing music as a creative modality in healthcare so patients, families, healthcare professionals, management team and local communities all benefit.

Benefits of Listening to Music

Several studies conducted by nursing academicans present the use of music as an effective, noninvasive intervention in creating a healing environment to promote health and well-being.  Below are the main points on the physiological and psychological responses in listening to music (2-4):

  • Themes identified in art literature are similar with the values in nursing theory, i.e., beauty, personal sensitivity, celebration of life, compassion, consciousness, patience, dignity, spiritual healing, and expression of human experience
  • The arts (music) have a liberalizing effect…stimulating artistic creativity and creativity of the body in wellness and healingmusic-notes41
  • Music relieves anxiety, pain, increases feelings of relaxation, heightens the immune system, decreases blood pressure, pulse and breathing
  • Music affects emotions via the limbic system where memories are evoked in response to sensory stimuli
  • Reduces stress levels and feelings of isolation
  • Music may stimulate the release of endorphins – the body’s natural opiates and associated with pain relief and pleasurable emotions
  • Improves motivation and elevates mood.
  • Fosters comfort in uncomfortable situations
  • Listening to music increased salivary immunoglobulin A, serum melatonin levels, and decreased muscle rigidty.
  • Allows patients a sense of control in an environment that often controls them

music-notes21music-notes1music-notes21music-notes1

Another qualitative study confirms the benefits of music with patients with advanced or end stage cancer at a cancer center in Australia.  Patients’ and family comments included “aliveness,” “expanded consciousness in a context where life’s vulnerability is constatnly apparent.” (5)

Music offers the nursing profession the chance to explore new strategies to enhance their care, and can be part of nursing’s healing modalities in meeting patient outcomes. Nursing interventions have always been to support, facilitate, and validate; the use of music and other creative activities in healthcare settings is no different.

To heal means not only to become well, but whole…bringing the person back in harmony with oneself, including physically, cognitively, spiritually and emotionally.

Author, Daniel Pink, concludes in his book A Whole New Mind: why right-brainers will rule the future that “the detached scientific method is no longer sufficient in medical treatment and care…approach to patient care is changing from detached concern to empathy…nursing is an empathic profession and will be one of the key professions in an age where many technical services are being outsourced, e.g. x-rays outsourced to Bangalore radiologists, etc.  Empathy – touch, presence, and comfort cannot be outsourced; it requires emotional intelligence and compassion.”

Note: if you want the bibliography – email me.

 

Creative Interventions in Spiritual Care

An article in USA Today (March 18, 2009) references a study in the March 17, 2009 issue of JAMA (Journal of the American Medical Association) on the choices terminally ill patients make during their last few weeks of life.  The study showed patients who rely heavily on their religious faith were 3 times more likely to want intensive, invasive medical procedures like cpr when their hearts stop or being connected to a ventilator (breathing machine).  They also made fewer preparations for death, such as living wills, giving someone power of attorney, or filling out a “do not resuscitate” forms.

The lead author, Dr. Holly Prigerson of Harvard Medical School, theorizes that patients with strong religious faith may be “waiting for a miracle…” and are “more likely to think that life is sacred and that their job is to prove their faith to God by staying alive as long as possible, so miracles can be performed.” 

However, aggressive medical procedures may heighten physical pain and suffering in patients who are terminally ill.  Patients connected to a griefventilator are unable to verbally communicate and have meaningful conversations with their family and friends, which may cause more grief for family caregivers.  What this essentially translates to is invasive medical procedures in terminally ill patients may be associated with poor quality of death for the patient, and poor emotional adjustment for family caregivers who rely heavily on religious beliefs to cope.  However, the decisions made by patients and families to prolong life are individual and unique…there are no 2 situations alike, and therefore, must not be judged.

Another study of terminally ill patients with cancer and their partners show that the well-being of both patients and partners are interrelated.  Which implies that any unrelieved psychological symptoms of the patient increased the risk of long-term psychological morbidity of the surviving partners (Walsh S, Culpepper S, and Schmidt M. Testing the Efficacy of a Creative-Arts Intervention With Family Caregivers of Patients With Cancer. Journal of Nursing Scholarship, 2004; 36:3, 214-219). 

 

Health System Struggles with Spiritual Care 

sky

In the same USA Today (March 18, 2009) article, it cites several studies of the lack of services in spiritual care for patients and families with cancer – this is very sad, indeed.  Below are the main points of the article.  To read the rest of the article, click here.

  • Nurses, doctors, and chaplains could do much more to ease the spiritual suffering for patients with terminal cancer
  • More than 70% of patients (N=230) felt their spiritual needs were not met by hospital chaplains, religious communities or others in the health care system (Balboni, T. MD, J of Clincial Oncology 2007)
  • Doctors and nurses are usually uneasy on what to say when it comes to talking about God because they fear that they might be imposing their religious beliefs
  • Lack of traning or skills of health professionals to help cope with spiritual questions
  • Not enough hospital chaplains…many hospital facing dwindling budgets have cut their chaplain service

 Use Creative Interventions in Spiritual Care

 

paintpalette1writingmusic-notes1cw_hope-lodge-portrait5

In light of these new findings, implement Creative Interventions as an additional activity and treatment  in Spiritual Care, but not replace religious leaders or mentors, nurses, doctors or hospital chaplains.  Here are the benefits of Creative Interventions as it relates to spirituality in patient care:

  • Low cost intervention
  • Promotes emotional bonding between patient, family and friends
  • Fulfills and complies with JACHO and Commission on Cancer Standards in Patient Care (see ‘Advocacy and Accrediting Bodies’ under TOPICS in left sidebar)
  • Based on holistic model and psychoneuroimmunology, i.e., body-mind-spirit-emotional systems are biochemically based and connected (see ‘Science Supporting Creativity in Healthcare’ under TOPICS in left sidebar, and read Candace Pert’s book ‘Molecules of Emotion’)
  • Reduces pain levels
  • Creativity and the arts tends to the spirit…the medical profession tends to the body
  • Provides periods of enjoyment, meditation and reflection
  • The creative process and the arts can be viewed as a non-traditional form of prayer
  • Engaging in the creative process heals the spirit, and therefore, aids in healing the body, mind and emotions (again, read Candace Pert’s book ‘Molecules of Emotion)

“Making art has been of great help to me in my cancer/life journey. It is always interesting to see new members come to the art class for the first time and proclaim they have no art talent. Nonverbal expression is just as valuable, and some times more so to those of us who don’t have the words to express our feelings in processing life.” (Written in email by Creativity Workshop participant to Marti Hand, RN, Artist, Advocate for creativity and the arts in healthcare)

morning-glory2

Here’s a thought for you to absorb…

Medical treatment is fully effective only when the whole person is being treated – body, mind, spirit, emotion.