Rx:Listen to Music

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Rx: Listen to Music

Is listening to music good for us?  Does music help in healing medical ailments?  Is there science supporting the benefical effects of the arts?  These are just a few questions raised  and being studied by scientists across the globe. 

In a recent New York Times article (March 29, 2009),  Michael Roizen, MD – chief wellness medical officer of the Wellness Institute at the Clevland Clinic – states listening to classical music on a consistent basis suggests “decreases in all-cause mortality, reflecting slower aging of arteries as well as cancer-related and environmental factors.  Attending sports events like soccer or football offers none of these benefits.” (1)   He states he’s not sure if the decrease in all-cause mortality is due to stress relief or other properties. 

Dr. Michael Roizen is also studying the effects of singing to help patients with strokes to relearn language.  Remember the singing1999 movie “Flawless?”  The main character (Robert Deniro) suffers a debilitating stroke and is prescribed to take therapeutic singing lessons for his paralyzed larynx.  His music teacher is his gay next-door neighbor.  The outcome from taking singing lessons is positive, for relearning and regaining speech AND learning tolerance of different lifestyles.

Another researcher in neurocognition of music and language at U of Sussex in England, Stefan Koelsch, is studying the same subject, i.e., music-notes2active music participation by patients suffering from depression.  According to the Mr. Koelsch, “physiologically, it’s perfectly plausible that music would affect not only psychiatric conditions but also endocrine, autonomic and autoimmune disorders.”

The main purposes of the article was to shed light on the collaborative efforts of the music and medical fields to quantify the effects of music on patients diagnosed with certain disease conditions, and highlight several companies creating and marketing propietary music  for ‘medicinal purposes’.   Here are a few interesting points made in the article: unlike prescription medication with known side and adverse effects, listening to music has no side effects; prescribe music as a prescription, just like prescribing a drug or therapeutic modality. And finally, listening to music does affect mood and well-being.

Hippocrates2The therapeutic effects of music  is not new news…the method of delivering music, marketing and money needed for these new elaborate systems are.  WHO is paying for the high-cost of audio systems fit for concert halls in hospitals?  Instead, pay musicians to play in clinical settings.  Music is their passion and their presence will help humanize an environment that can be frightening and dehumanizing.

Florence Nightingale, the founder of modern nursing recognized the beneficial power of music on the sick. (2)  Hippocrates, the father of modern medicine, believed that the human body acts as a whole, so that when an organ is ill, the whole body is being afflicted, ie., humans are psychosomatic entities. (3)

Numerous investigations on the effectiveness of music on adult patients in critical care settings in the 1990′s showed reduced anxiety states (4-6),  physiological relaxation as evidenced by reduced vital signs (blood pressure, heart rate and respirations), improved mood in critically ill patients on mechanical ventilation (7-8), and published accounts indicate critically ill patients enjoy and find music helpful in dealing with the environment and in coping with the critical illness itself .(6,9-10)

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For healthcare professionals working inpatient and outpatient venues, and families with a loved one going through medical treatment, try music as a creative intervention by gathering the following:

  1.  Headset
  2. iPod or CD player
  3. Playlist of the patients’ favorite music – soft, classical or sounds of nature
  4. Play the music on a consistent basis

Here’s my Rx for you…

‘Time to Say Goodbye’

by

Andrea Bocelli & Sarah Brightman

 

Note: email me if you want the bibliography marti@martihand.com

 

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?

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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?

Celebrating International Nurses Day – May 12, 2009

Every year, May 6 begins National Nurse’s Week in the US, and ends May 12, designated and recognized as International Nurses Day and the birthday of Florence Nightingale, the founder of modern nursing.

“For me, nurses are the unsung heroines and heros of the health profession.” ~John Sentamu, Bishop of Westminster Abbey

peopleglobeGlobally, May 12 is designated as International Nurses Day (IND) by the International Council of Nurses.

In the US, May 6 - May 12 is National Nurse’s Week.  The theme for this year is “Nursing: Building a Healthy America.”  The week was established to recognize and honor nurses who meet the health and mental health care needs of the  nation, and for the quality work they provide seven days a week, 365 days a year.  Also, nnw09National Nurses Week focuses on highlighting the diverse ways in which nurses are working to improve health care. From bedside nursing in hospitals and long-term care facilities to research institutions, state and national governments, the nursing profession is meeting the ever expanding health care needs of society. The 1st National Nurse’s Week was observed from October 11-16, 1954. The year marked the 100th anniversary of Florence Nightingale’s mission to Crimea. In 1994, the American Nurses Association’s Board of Directors designated May 6 – 12 as the official dates to observe National Nurses Week, and established them for all subsequent years. 

Facts, quotes & comments about nursing and nurses…

  • According to Kirsten Stallknecht, president of the International world_mapCouncil of Nurses (ICN), there are more than 11 million nurses worldwide providing care in hospitals and rural health centres, schools, workplaces, homes, prisons, war zones and refugee camps.
  • There are nearly 2.9 million registered nurses in the United States, and 2.4 million of them are actively employed.
  • “It’s hard to live with a nurse because… unless you are bleeding profusely, with bones protruding from the skin, and you can’t breathe, you won’t get any medical attention or sympathy.”  ~every nurse’s significant other
  • “I am fond of nurses.  They treated me well.  They help people.” ~9 year old schoolgirl, Botswanahands
  • The International Council of Nurses (ICN) is a federation of 133 national nurses’ associations representing the millions of nurses worldwide. Operated by nurses for nurses since 1899, ICN is the international voice of nursing and works to ensure quality care for all, sound health policies globally, and the advancement of nursing knowledge.
  • According to projections released in 2006 from the US Bureau of Labor Statistics (BLS), growth rate for RNs will exceed 21% from 2006 to 2016.
  • “Nurses are committed to caring for all persons nursesacross the life cycle: pregnant women, infants, children, adolescents, adults, and the elderly. They are also there for the most vulnerable groups, such as the poor, refugees and displaced persons, street children, and the homeless…it is this element of humanity and caring that sets nurses apart.” Kirsten Stallknecht, president of the International Council of Nurses (ICN).
  • “My discovery, as a patient on the medical service and later in surgery, is that the institution is held together, glued together, enabled to function as an organism, by the nurses and by nobody else.” ~Lewis Thomas, MD in ‘The Youngest Science’
  • “Nurses have been pivotal to my own recovery and health.  I supermanknow this is also true for millions around the world who are restored to health and comforted in illness by the caring, compassion and expertise of nurses.” ~Christopher Reeve, actor and director
  • In the US, nurses were ranked first for 8 consecutive years for their honesty and integrity, with 85% of Americans rating them “high” or “very high,” according to the 2008 Gallup Poll.gallup
  • In every region of the world, the public consistently rates nurses and nursing as the ‘most admired profession’. Polls taken in Australia, the US , the UK and other countries and regions indicate that up to 90% of the public ranks nurses #1 over all professions. (ICN, Geneva, Switzerland, May 12, 2000)
  • “I know that nurses will continue to be there when it is needed – when people suffer and the vulnerable need care and assistance.” ~Dr. Gro Harlem Brundtland, Director General, WHO
  • 24/365  = the hours in the day and days in the year that nursing care is ‘there for you’
  • A Pittsburgh based medical apparel company, on+qor, has produced a music video in tribute to the nursing profession. The video can be seen on http://www.onqor.com/nurses/.  

 And the most famous nurse…Florence Nightingale

Nightingale

 

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In celebration of International Nurses Day…

NURSES Fingerprint Portrait (TM)

To see a much larger image, read the ‘fingerprinting’ and for prints, click here

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(the actual fingerprint is mine)

Thank every nurse in your life!

Exemplary Arts Programs in Healthcare

“Rome fell because of a leaching away of meaning and a loss of faith.”  ~lewis mumford

A few years ago, I spent many hours researching periodicals  and other sources to glean information on scientific research supporting the arts in healthcare systems.  The research was in preparation for a proposal I was writing for developing an arts program for a metro-Atlanta healthcare facility.

While researching, I learned of a plethora of hospital systems with arts programs mhand_bodymindsoulemotionvarying in degree of comprehensiveness, from small galleries to well-developed arts programs that spoke volumes of the mission and values of those organizations and their leadership.  Clearly, these hospital systems valued and believed in holistic care, and created an environment conducive to healing on multiple dimensions: body-mind-soul-emotion.  They were the pioneers, believing in the benefits of the arts and implementing such programs without needing scientific data.  Those who managed these organizations gave their hospitals - souls.

Although there are a number of healthcare organizations with arts programs here in the US, there are 3 worth mentioning because of their early vision and date of inception.  What started off small led to developing other forms of arts programming for patients, staff and local communities, thereby, fostering goodwill and unity with oneself, families, healthcare staff and local commUNITIes.

“We know too much and feel too little. At least, we feel too little of those creative emotions from which a good life springs.” ~bertrand russell 

University of Iowa Hospitals and Clinics Project Art, Iowa City, Iowa

Starting as early as 1976, prints were purchased for public areas in an effort to humanize the hospital.  The positive response from patients, visitors and staff to the paintpalette1increased presence of visual arts led to conducting a feasibility study in 1977 which recognized an interest in and a need for art in the health care environment. Project Art was inititated in 1978.  Project Art started with small, temporary, monthly art exhibits and leasing of art to adding other creative activities such as the Art Cart and Art Supplies for Patients.  Performing Arts events feature music, dance and theater.

In 1997, JCAHO (aka Joint Commission) upon reviewing UIA stated the following…

“Throughout its development and to its core, University of Iowa Hospitals and Clinics believes that it must not only assemble the human expertise to make the healing, education and research components of its mission possible, but also must create an environment that promotes both healing for the patient and respite for the family. Call it the ‘environment of care…’ (Doing The Right Things Right, Joint Commission on Accreditation of Healthcare Organizations, 1997.  UIA Project Art website).

janet2(self-portrait by participant in Creativity Workshop for People with Cancer, 2007)

Duke University Medical Systems Cultural Services Program, Durham, NC

Duke University Hospital’s Cultural Services Program is another pioneer in integrating the arts. Established in 1978, initial projects began with installing original North Carolina artwork in patient rooms; an exhibition program; and performing arts events booksfor patients, visitors, and staff.  Employee specific programs including dance workshops, annual arts and crafts festival, an annual stage production, and weekly literary meetings.

Duke’s mission is to integrate the arts and humanities into the life of the Medical Center, bringing the healing power of the arts to people who are suffering and to those who care for them, including staff and students.

Shands Hospital, University of Florida, Gainsville, FL

The Arts In Medicine program (AIM) at the University of Florida, Gainesville, was co-founded by nurse-artist, Mary Rockwood Lane and physician-poet, John Graham-Pole. The AIM program was created in 1991 in response to perceived needs of caregivers to re-humanize medicine.  The first arts program began with community artists, carefully screened by Lane, to work with patients on a one on one basis at the bedside in the bone marrow transplant unit. 

The program was well-received by the entire hospital ultimate_creativity_for_siteand expanded to other units serving a broad spectrum of patients. The artist in residence (AIR) program has become a model to incorporate the arts into the mainstream of clinical practice. The purpose of the artist-in-residence was to integrate the arts into the care giving of patients as well as to educate staff and students into the new approach of caring.

According to Dr. Graham-Pole (co-founder), the AIM program brought creativity into his own life. He believes “the release of human creative expression among children and adults in various stages of pain and physical ravage is a unique tool to be used alongside the medicines and treatments that accompany any serious illness”.

Other noteworthy U.S. arts programs in healthcare are:

  • Vanderbilt University Medical Center Cultural Enrichment, Nashville, TN
  • Stanford University Medical Center Hospital and Clinics, Stanford, CA
  • Lombardi Comprehensive Cancer Center at Georgetown University, Washington, DC
  • Hasbro Children’s Hospital, Providence, RI
  • The Creative Center: Arts for People with Cancer, New York, NY
  • Massachusetts General Hospital Cancer Center, Boston, MA 

How is the soul of your healthcare organization manifested?

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(‘STILL pondering infinity’  Marti Hand, 2008)

To read about ‘STILL pondering infinity’ click here

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

New York Nurses Score Huge Victory Against Large Hospitals

Although the main purpose of this blog promotes integrating creativity and the arts in healthcare, this blog also promotes nurses and the nursing profession, an integral and valuable profession in the healthcare industry.
northeast-health_ny
 
Here’s some very distrubing news about illegal maneuverings by a healthcare network in northern New York against nurses.  Northeast Health, a network of hospitals which includes Albany Memorial and Samaritan Hospitals settled a class-action lawsuit alleging hospitals in upstate New York had for years violated federal antitrust law by sharing confidential wage data and conspiring to depress wages for registered nurses. Nurses hailed the settlement as an important step towards ensuring fair compensation for their profession and helping to solve the nurse shortage crisis, thereby improving quality of care for patients.

Northeast Health of Troy, N.Y., agreed to pay $1.25 million in a settlement that was filed on March 9, 2009 in U.S. District Court in the Northern District of New York.   The settlement is subject to court approval and includes provisions to halt anti-competitive behavior by Northeast Health in the future. These provisions prohibit Northeast justiceHealth from sharing current and future nurse wage information with other healthcare facilities in the Albany area, and give plaintiffs access to Northeast Health witnesses in order to further prosecute the action against other area defendants.  Northeast Health is the first among Albany area hospitals to “settle out” of the lawsuit and similar suits are moving forward in Detroit, Chicago, San Antonio and Memphis.  The company did not admit any wrongdoing and called the allegations in the lawsuit “completely false and offensive. (They’re not going to admit to exploitation and greed!)  About 2,500 nurses are represented in the class.

“We never conspired with any other hospital to suppress nurse wages, nor did we ever violate the antitrust laws in any manner,” the hospital network said in a statement.

“This is a breakthrough not only for nurses, but for the people we care for every day. For too long, hospitals cut corners when it came to valuing the hard work of nurses. Our hope is that this is the first step towards making exploitation1sure that hospitals invest in the kind of quality care that patients deserve,” said Cathy Glasson, RN, of the Nurse Alliance of SEIU.  “By helping to ensure competitive methods for setting RN wages, we can attract more new nurses to the profession, bring non-practicing nurses back to the bedside, and improve patient outcomes,” said Anne Jacobs-Moultrie, RN.

The suit, brought by two Albany, N.Y., nurses, is one of five related suits filed in 2006, in which nurses alleged that hospitals agreed to enter into a conspiracy to keep nurse wages artifically low and did so by sharing compensation information such as wage surveys. The SEIU Nurse Alliance has played a leading role in supporting empirical research that has exposed the national problem of employer collusion around nurse wages, shown the link between wage levels and the shortage of bedside nurses, and demonstrated the importance of staffing levels for improving patient care.

Heidi Hartmann, president and labor economist at the Institute for Women’s Policy Research, said the settlement was significant and could have a spillover effect on the related cases. One company’s settling could set a precedent for the other defendants, she said.  There are  four related suits across the country. 

Below are links to the press coverage in various newspapers:

 

First of all, I was shocked and dismayed to read about the illegal activities in artificially depressing RN wages and salaries by the New York hospitals.  In so greedydoing, the hospital management team not only contributed to the growing nursing shortage, but also put patient lives at risk (!).  I wonder if any of the hospital management team had any family member(s) in hospitals in northern New York? Most likely not, because low nurse-patient staffing ratios  are directly linked to the quality of patient care.  Northeast Health joined their brethren on Wall Street where greed, fear, short-sightedness and taking advantage are the main goals.  ‘Taking advantage’ is defined in the dictionary as “to profit selfishly by exploitation.”

I realize many hospitals are non-profit and many function in the red due to a number of uncontrollable factors in the healthcare system, such as pre-existing condition policies by insurance companies…use of emergency departments as primary care visits…treating the indigent…close to 46 million Americans uninsured (or 18% of population under 65 years)…the underinsured…denial of reimbursement by insurance companies…unhealthy health conditions of  US people…escalating senior population due to aging baby boomers…increasing number of chronic health conditions…living longer…

However, there is no excuse for ‘taking advantage’, of nurses who’s main goal is helping people.

Here’s a quote that’s very applicable to the above news article…

 “You must not loose faith in humanity.  Humanity is an ocean; if a few drops of the ocean are dirty, the ocean does not become dirty.” ~ gandhi

buddha

(an old boring book I transformed to a Book of Quotes)

Nurses are the backbone in healthcare, providing the infrastructure, foundation, support, and mortar in all healthcare organizations.  Without nurses, there would be no health services, no healthcare organizations and no healthcare dollars fueling the largest industry in the economy.  Nurses are firmly planted in insurance companies, public and private medical centers and hospitals, specialty outpatient centers, outpatient clinics, medical offices, schools, the legal system, public policy and long-term care industries, to name a few.  In fact, if you are observant, you will notice nurses working in every industrial sector, both great and small, of the economy.

And justice for all…

justice11

Use of Drawing in Disability Research

I just read an interesting article on the use of drawings as a way to understand the personal experience of persons with spinal cord injuries.  The drawings were part of a larger study focused on the community integration and participation of adults with spinal cord injury. 

But, first some facts and figures on spinal cord injuries (SCI) from the National Spinal Cord Injury Statistical Center:

  • A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the spinalcord1moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries to the spinal cord don’t completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis.
  • There is an estimated 10,000 – 12,000 spinal cord injuries every year in the US.  
  • A quarter of a million Americans are currently living with spinal cord injuries.
  • Costs: The average yearly health care and living expenses and the estimated lifetime costs that are directly attributable to SCI vary greatly according to severity of injury.

sci-table1

  • Since 2005, the most common cause of all spinal cord injuries are due to car accidents followed by falls (27%) followed by violent encounters sci(gunshot wounds). The rest are due to sporting accidents, and work-related accidents.  Interestingly, the proportion of injuries due to sports decreased over time while the proportion of injuries due to falls has increased. Acts of violence caused 13.3% of spinal cord injuries prior to 1980, and peaked between 1990 and 1999 at 24.8% before declining to only 15.3% since 2005.
  • The average age at injury is 39.5 years.
  • Since 2000, over 75% (77.8%) spinal cord injuries reported to the national database have occurred among males.

(Source: Facts and Figures at a Glance, updated February 2009. National Spinal Cord Injury Statistical Center)

  Now, back to the article…

The research project titled, ‘Images of self and spinal cord injury: exploring drawing as a visual method in disability research,’ (VCross K, Kabel A, Lysack C. Visual Studies, Vol.21, No.2, Oct 2006, p183-193)used drawings by persons with SCI which provided unique insights into the personal meanings of spinal cord injury and how this injury is understood and represented to others.  The purpose of the study was to use paticipants’ own drawings as a useful adjunct to the traditional narrative approach.   The 2 specific questions to elicit drawings were “Draw your self.” and ”Draw how you see spinal cord injury in your mind.”

Drawings of ‘Self’

The drawings fell into 3 categories: 1) drawings that included a wheelchair; 2) drawings that didn’t include a wheelchair, 3) drawings where ‘the self’ was depicted as a head or a head and torso only, with no reference to paralyzed limbs.  Below are the social researchers’ analyses of the drawings:

  • depth and intensity of mhand_bodymindsoulemotionparticipants’ feelings went unrecognized until the drawing task.  I am not surprised by this at all…engaging in the creative process allows the spirit/soul to assume control and communicates with the body, mind and emotions via complex biochemical pathways.  See my diagram to the right ->
  • Participants didn’t deny that their body had deficits, they did not consider those deficits important or relevant to ‘who they really were.’
  • Physical disabilites invites misperceptions by non-disabled persons as ‘not normal,’ based on their appearance rather than on ‘who they really are.’ 
  • Participants with SCI recognized that ultimately they need to adjust their own impressions and perceptions of disabled persons.

Drawings of “Spinal Cord Injury”

One of the goals of the study was to understand how individuals disabled by SCI understood the injury.  The majority of drawings fell into 3 groups: 1) anatomical drawings, 2) metaphorical drawings, and 3) abstract drawings. Here are the findings:

  • SCI represented a literal ‘break’ of the bones and  nerves
  • Feelings of powerlessness to change or reshape  social interactions and negative social attitudes about disability.
  • Abled-body persons more accepting if persons with SCI downplayed their disabilities.  There is pressure to conform to non-disabled societal expectations and views of ‘normal’

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Of interest…

The U-M Model Spinal Cord Injury Care System, part of the University of Michigan Health System, is one of the 14 institutions to be classified as a Model Spinal Cord Injury Center by the National Institute on Disability and Rehabilitation Research (NIDRR).  Interestingly, University of Michigan Health System has a comprehensive arts-in-healthcare program titled “Gifts of Art.”  On their website is this description:

“During times of stress and illness, the arts have the power to nurture and engage. Gifts of Art programs utilize the arts to assist and enhance the healing process, reduce stress, support human dignity and renew the spirit.”

If one of the purposes of healthcare is promoting health, wellness and recovery – why aren’t there more health systems, including public health systems, more open-minded and holistic like University of Michigan Health System?  Healing and caring for people is more than attending to the physical body…it’s addressing the whole person – body, mind, spirit, emotions.

Guest Writer – Sara Baker

I invited a guest to write this week’s post – Sara Baker. 

Sara is a novelist, short story writer and dramatist. Her works have been published in a number of publications. Her screenplay, ‘Looking for Sylvia’, was a sara-bakerwinner in the Atlanta Film and Video Contest; her screenplay, ‘One of Us’, was a semifinalist in the Cinestory 1997 Screenwriting Contest. She has written three books – 2 novels (Shadow Dance and Horography), and a collection of short fiction titled ‘No Part of the Body is Not Sacred.’  Sara holds a Masters degree from Boston College. She has taught English at the University of Georgia, Georgia Institute of Technology, and Piedmont College. In addition, she has been a Georgia Artist in the schools and conducted workshops throughout the state. Sara created the Woven Dialog Workshops, writing workshops that aid in facilitating the healing process at Loran Smith Center for Cancer Support in Athnes, Georgia.

Read more about Sara at her website Sara Baker titled “Woven Dialog Workshops,” and blog ‘Word Medicine.’

 

And now, here’s Sara…

 

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Returning to the Roots of Western Medicine

The arts in healthcare are often regarded as a nice but certainly not essential component of patient care, just as the arts in the broader American culture are often considered a valuable but inessential asset. Certainly, they are not considered essential to our well-being. We are a pragmatic nation, proud of our technological prowess. We are more comfortable with the Newtonian idea of the body as a machine to be fixed than as the physical expression of a soul.

Yet the very roots of Western medicine are sunk deeply in a tradition which proceeded from a very different premise. In ancient Greece, the hippocratesill would go to healing temples, or temenos, which means a piece of land cut off or set apart and dedicated for sacred purposes. The temples dedicated to healing were call asclepieia, after the god of healing, Asclepius. The sick would come and bathe in healing waters and prepare themselves for a sacred dream, which they would then report to a priest, who would prescribe a cure. The earliest of these temples date from 420 BC, and both Hippocrates and Galen trained in asclepieia, and Hippocrates traced his ancestry to Asclepius.

What the ancient Greeks understood and what Hippocrates espoused, was that a person carried within themselves the resources to help direct their healing. They understood that the unconscious often held the key to healing and allowed a time and place for that knowledge to arise.

It has been said that if you listen well to a patient, he will give you the key to what is wrong with him. Yet in our modern medical environments, there is little time for truly listening. And the language of medicine is one that often reduces the ill person to a body or a pathology, rather than addresses the emotional and spiritual experience of the person undergoing the experience of illness. (see Arthur Frank, At the Will of the Body). Chaplains and social workers, those assigned to “deal with” these issues, are often overburdened. butterfly1Patients themselves often feel as if they are somehow wrong to have feelings of despair, disempowerment, grief, and stress and lack the language to acknowledge or access feelings which may actually, by their lack of expression, be blocking their healing process.

By providing arts experiences in hospital settings, however, we are providing our own temenos. Here, in the safe space set apart from other concerns, patients are invited to have a healing, although waking, dream. They are able to find the symbolic language to express the crisis they are experiencing, and also, through the process of art, to seek new, imaginative ways to go forward. Thomas Moore, author of Dark Nights of the Soul, talks about the “unfolding self,” the part of us that is always evolving and going through deep transformations. “The unfolding self hungers for symbols and language to understand and mark the transitions it is going through.” (pg. 35) Through the process of creating art, the patient-artist both creates the distance necessary to reflect on his/her experience and honors the transformative process that is always part of the experience of illness.

In many respects, then, incorporating art into the healthcare setting is writingnot something new, but something very old. It is an acknowledgement that healing is not only about curing physical ills, but also about giving patients the tools to cope with the spiritual and emotional dimensions of illness. The science supporting the physical and emotional benefits of arts intervention is growing exponentially (see Marti’s excellent “The Science Supporting Creativity in Healthcare). Medicine has always been a blending of art-intuition, perception, creativity-and science-knowledge, skill, experience. While the current structure of our medical system so often mitigates against providing healing environments that address the whole person, my experience has been that all those involved in healthcare want such environments. By incorporating the arts as healing modalities, hospitals are returning to the roots of Western medicine. ~sara baker.

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Don’t forget to visit Sara at her website Sara Baker titled “Woven Dialog Workshops,” and blog ‘Word Medicine.’

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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

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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

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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.