Tag Archives: patient advocacy

Do you know how to be your own best patient advocate?

In ‘To Err Is Human: Building a Safer Health System’ report, the Institute of Medicine’s (IOM) estimates 98,000 people die from preventable medical errors. The likelihood of experiencing a medical error is about six percent for each day in the hospital (IOM, 2000)

You are your own best advocate. If you can’t advocate for yourself, get your family members and friends to advocate for you by following these tips. These safety tips are summarized by Donna Crisp, author of Anatomy of Medical Errors: The Patient in Room 2You will access the healthcare system at some point in your life, and need to be actively engaged in your care. It is your life after all.

Become Your Own Medical Consumer Advocate:

  • Pay attention, even if you must detach from your emotions as a patient.
  • Ask questions and take notes.
  • Remain skeptical and alert.

    be-your-own-best-patient-advocate

    Ask questions!

  • Identify your assumptions and validate them.
  • Never assume you are being told what you most need to know, much less all you need to understand.
  • Make sure you or someone with you knows what medication you are prescribed and given, and for what purpose. Remember that medication errors are common in hospitals. Realize that you may refuse medication for any reason.
  • Whenever possible, have someone act as your advocate and witness.
  • Learn as much as possible about your health issues so you can formulate relevant questions and concerns to share with your physician or other caregivers.
  • Realize and remember that sickness and treatment are about much more than a physical problem, disease, or trauma: They are also about suffering, fear, anxiety, loneliness, support, and hope.

After You Receive Bad Health News:

  • When you hear bad news, do not necessarily assume it is true. It might be, but become your personal devil’s advocate. Do not allow fear to be your driving force. It is not unusual for a second opinion to yield a different diagnosis. A second opinion may be essential to confirm a correct diagnosis and, as well, may give you more treatment options for consideration. Always get a second opinion.
  • Ask other people—a neighbor, colleague, friend, family member, or someone from your religious community or groups of interests—if they know anything about your diagnosis. When I asked people about uterine cancer, several people told me there was a high success rate with surgery, assuming the cancer had not spread. This immediately gave me hope.
  • Find out which doctor has the reputation for being the best person to help you, but remain skeptical—even bad doctors have fans. If you personally know people who work in healthcare, such as a nurse or physician, ask them who they would go to—and why—if they received your diagnosis.
  • If you have more than one hospital to choose from, learn how various hospitals deal with your problem. For example, breast cancer treatments vary widely depending on where you live and which hospital you choose.
  • The Internet provides comprehensive information about most knowledge-empowers-youanything; make sure you use only reliable sources—websites such as MedlinePlus from the U.S. National Library of Medicine, WebMD, Sharecare, or the Mayo Clinic. Unscientific blogs may confuse or alarm you as it’s difficult to verify their stories or claims.
  • Finally, remember that knowledge is power. Learning about your health crisis may not only guide your choices, it may also empower you with a sense of control during a time when life feels scary.

Before You Go for Healthcare:

  • If possible, have your affairs in order, especially your legal will and your advance directives—living will and healthcare power of attorney. Prepare for the worst scenario and hope for the best outcome. Take copies of your advance directives with you when you go for treatment. Also, tell your friends and family what they might need to know in case you do not come home on schedule, or worse.
  • Make arrangements for your home, pets, mail, and other matters you will not be able to attend to while out of commission.
  • Items you may need include personal telephone, watch or clock, pen and paper, contact information for people you might need to talk with, and reading material—preferably something that inspires you.
  • Make sure you tell your loved ones ahead of time how you feel about visitors—which ones and how often. Since I planned to be home about 24 hours after entering the hospital, I expected to have no visitors, only the friend who was with me. Later, my family knew I would not want visitors while I was in a coma.

While You Are in the Hospital:

  • Have someone with you as much as possible—someone who is not afraid to ask tough questions or speak up if something does not seem right, someone who can help make decisions (or call the right people) if something goes wrong. Choose a person who is brave enough to risk being seen as inappropriate or meddling. It is better to appear foolish than to risk saying nothing, in case something is not right. There is nothing more important than your physical and emotional well-being when you are under the control of a medical system.
  • If your doctor or nurse (or someone else) is not giving you the right care or is not treating you with respect, ask to speak with someone in authority, such as the nursing unit manager, the nursing supervisor, the doctor’s supervisor, or the administrator in charge. If you do not know how to contact any of these people, pick up the telephone and dial the operator for assistance. I once knew a woman whose arms had been severely injured, leaving her unable to wipe herself in the bathroom. When I learned that a nurse was not helping her with that don't-be-afraid-to-ask-questionschore, I spoke to the unit manager to insist the nurses perform correctly.
  • If you cannot get the nutrition you need, ask someone to bring you food you can eat.
  • In general, do not be afraid to ask for anything that might help you, even if you think your request cannot be met. You never know. And, if you cannot speak for yourself, make sure you have a personal advocate who can look after your needs. Staffing shortages are common in hospitals.

Click here to print a pdf version. Share with others broadly.

In Defense of Writing…

This post is written by a graduate in English literature turned nurse – Sashana Macatangay.  She is enrolled in the Master’s in Nursing program at Azusa Pacific University.  Sashana believes the act of writing helps with clarity of thought, sharpens critical thinking and observational skills, and last but not least, that the humanities should be incorporated into nursing curriculums.  And why you may ask?  This is Sashana’s story and explanation…

Florence Nightingale, the most celebrated pioneer of the nursing profession, once likened nursing to an art. From Nightingale’s perspective, nursing was, in nightingale-creativityinhealthcarefact, “the finest of the Fine Arts.” She makes a valid argument. In her analogy, Nightingale aptly compares the work of a nurse to that of a painter or sculptor. Both disciplines require exclusive devotion and hard preparation. Both also incorporate a strong human aspect. Because of this human aspect in nursing, it is important that nursing students exercise skills in the Humanities, particularly writing. Good writing skills in any discipline serve the purpose of promoting individuality, sharper critical thinking skills, and the formation of more articulate thought processes. In nursing, specifically, writing skills help to promote professionalism, credibility, and the dissemination of useful healthcare-based knowledge, which is valuable to hospitals, clinics, and care facilities everywhere.

I am contributing to this blog because I wish people to know why I believe writing is necessary in nursing education. I am well aware that the bulk of nursing students absolutely detests writing and do not share the same opinion as I do. Hopefully through this article, I will have provided a solid argument writing-creativityinhealthcaredefending the importance of writing. However, before I expand more on why I believe writing is important to nursing, it should be noted that I might be a little biased due to my academic history. I graduated with a liberal arts degree—more specifically, an English degree. I made the decision to change my career path several years ago, and I am currently more than half-way finished with my second degree in nursing.

But let’s not lie. My initial attraction to the nursing career was a bit more superficial. During my years as an undergraduate student of UC Irvine’s School of Humanities, my goals were much different. I planned on pursuing a career as a music journalist. I dreamed of securing a position at Rolling Stone or Spin. I was determined to get there. However, the sad reality of the music journalism career made itself evident when I applied to a handful of alternative music magazines with no actual success. A long period of taking out odd jobs and engaging in continuous soul-searching prompted me to consider nursing as a way to financially stabilize myself and help provide for my family in the future. It wasn’t the most pure reason for wanting this career, but it’s the truth. I was a girl in her early 20s who loved music, art, and literary prose. I even manned my own radio program as a DJ at Orange County’s KUCI and was heavily involved with the non-profit organization for several years. In the past 5 years, I’m sure that no one would’ve ever guessed that the beats per minute I would be counting would be heart rates, and not the speed of a vinyl record.

However, before you judge me too much about my initial attraction to the stability of the nursing career, please note, that I grew to love it. Why do I love it? Well, while many uninformed people consider nursing to be a mere science, I consider it an art. True, I did graduate with a liberal arts degree, and to many people, this has absolutely nothing to do with nursing. I have a completely different perspective on the relevance of my degree. In my mind, these two different courses of study are similar. The English major analyzes texts from different perspectives in search of literary truths. In a similar vein, the nursing student analyzes data and different variables, from different angles, in search of medical truths in the form of comprehensive diagnoses. I appreciate the multidimensional nature of nursing, and I love the different approaches and interventions that can be taken to address any single problem. Everyday is a constant exercise of critical thinking and creativity.

And believe it or not, I do also love the writing and research aspect that is involved in nursing. Uncovering life-changing data and making a difference in the world through the spread of knowledge and ideas is a very rewarding process that I would like to one day take a part of. For this reason, I’ve always believed that writing is one of the most important aspects of the nursing profession. In fact, according to Provision 7.3 in the Nurse’s Code of Ethics, “…nursing knowledge is derived from the sciences and from the humanities. Ongoing scholarly activities are essential to fulfilling a profession’s obligations to society” (“Code of Ethics,” 2001).

Writing is one of the most important scholarly activities that a nurse can engage in. Eloquence and proficient writing skills in nursing practice indicate competence, expertise, and wisdom in clinical practice. These skills can draw attention not only to the nurse’s expansive and specialized medical lexicon, but also to their extensive knowledge of relevant healthcare-related issues (which proves to be highly beneficial in patient-centered care).

Effective communication skills lend more credibility to the nurse, enabling the nurse to be a more effective and trusted patient advocate. As a result, the nurse may also use her unique writing style to expand and diversify the pre-existing body of healthcare-based knowledge that is used internationally in promoting more effective patient care.

Writing promotes a nursing culture of professionalism and aids in the spread of knowledge and ideas among patients and nurses alike. But if this reason alone is not enough to demonstrate its importance, we must also consider the scarcity of creative assignments in nursing education, which can be all too systematic and structured.

Nursing students rarely get the opportunity to express themselves as individuals. They are mandated to learn the same skills, and they must exercise these skills under a strict protocol. Their form of self-expression is often limited to a mechanical regurgitation of knowledge and hard, scientific facts. Creative processes such as writing promote individuality, critical thinking, and innovation. As nurses, we must exercise writing in order to establish what Theresa S. Drought in The Guide to the Code of Ethics for Nurses describes as “…new ways of understanding disease, health, the human response to illness, and innovations in nursing care” (Drought, 2008, p. 95). Writing is essential for stimulating self-expression, originality, and innovation in a profession that thrives on advanced practice research, evidence based practice, and scholarly inquiry.

Proper writing skills and the exercise of creative thought is paramount to the success of any professional within the healthcare industry. Nursing is certainly not exempt from this. Nursing curriculums often have a heavy emphasis on clinical skills and science-based knowledge. However, what many people fail to realize is that nursing is both a science and an art. Incorporating more writing into nursing education is beneficial because nurses who are strong writers are also strong communicators. Consequently, they are also more vocal patient advocates. As healthcare professionals, we must be aware that the exercise of sharing ideas and contributing interdisciplinary knowledge is a collaborative process that we all should participate in.

If you wish to connect with Sashana, email her at sashanamac@gmail.com.

Planetree: a model for Patient Centered Care…

Have you ever heard of Planetree?  I learned of this intriguing non-profit organization a number of years ago and of  their mission to help health care organizations develop patient centered environments.  Their care models focus on “healing and nuturing body, mind and spirit” representing a multi-dimensional, holistic approach and attitude to patient care and treatment.

Planetree’s history is equally interesting.  It was founded by Angelica Thieriot in 1978 after her hospital experience battling a rare viral infection.  Back then, hospitals were hardly examples of healing environments that fostered multi-dimensional recovery from illness.  Focus of health care was on treating the disease or ‘sick-care’ rather than ‘health-care’ of  patients and families.  The medical model took precedence over patient centered approach leading to a depersonalized and fragmented system, and is how health care functioned for decades.  However, all is not lost!

The Planetree model of care is a “patient-centered, holistic approach to providing patient care, promoting mental, emotional, spiritual, social, and physical healing. It empowers patients and families through the exchange of information and encourages healing partnerships with caregivers. It seeks to maximize positive healthcare outcomes by integrating optimal medical therapies and incorporating art and nature into the healing environment.” (www.planetree.org)

I love Planetree’s simple and eloquent,  yet powerful,  philosophical beliefs.  They (and I) believe…

  • that we are human beings, caring for other human beings
  • we are all caregivers
  • care giving is best achieved through kindness and compassion
  • safe, accessible, high quality care is fundamental to patient-centered care

  • in a holistic approach to meeting people’s needs of body, mind and spirit
  • families, friends and loved ones are vital to the healing process
  • access to understandable health information can empower individuals to participate in their health care
  • the opportunity for individuals to make personal choices related to their care is essential
  • physical environments can enhance healing, health and wellbeing
  • illness can be a transformational experience for patients, families and caregivers

To learn more about Planetree, visit them at www.planetree.org.

plane-tree

According to legend, Hippocrates sat under the boughs of the plane tree to teach his pupils the art of medicine.

Is it Art Therapy?

When I conduct the Creativity Workshops in healthcare environments, someone never fails to ask me if I’m an art therapist – I am a Registered Nurse and artist.  People automatically assume, and understandbly so, one must be an art therapist when working or helping patients wih art.  As an artist and nurse, I want to introduce the idea and concept of what the arts can do for patients.  Engaging in the creative process, the arts, is healing and should be integrated into healing environments – into hospitals, outpatient treatment centers, doctors’ offices, the VA, residental centers, long-term care facilities (nursing homes), home care, and hospices.

When you engage in a creativity activity, aka the creative process, you become your own therapist.  The therapy (which you facilitate) is to access that space that is intuitive, invisible, intangible, healing, and brings you comfort and pleasure by creating a tangible object.  It can be a painting (in my case), a beautiful garden, poetry, a book or journal, a crafted piece of work, a short story, playing music, singing, helping others, drumming – the medium is not important.  Whatever you are experiencing or feeling will manifest outwardly in your creative project.  Now, this is not to say art therapy is not necessary…it may be for certain individuals who need individualized professional counseling. 

So, the question of “Is it art therapy?” still remains unanswered.  The answer is “yes”, but not in the traditional sense of the title ‘art therapy.’  The nurse/artist/social worker/physician/creativity facilitator is an advocate of creativity by facilitating and encouraging art-making… the patient is her/his own therapist by willingly engaging in the creative process…the therapy is the actual art-making itself.

From review of the literature, incorporating creativity into nursing’s framework of care is more practical, versatile and non-threatening over other therapeutic models, i.e., therapy.  In nursing terms, creative activities can be referred to as “creative nursing interventions.”  Traditional psychotherapy may not provide the best approach to working with patients, because most patients do not view themselves as needing psychotherapy.  Engaging in the creative process is what facilitates healing at the spiritual, emotional, cognitive and physical levels.  In fact, many patients may feel threatened if an arts program is referred to as art therapy.  Rather, patients want to gain a sense of control of an unfamiliar environment. (1)

Email me if you want the bibliography.

Rx:Listen to Music

music-notes2music-notes11music-notes11

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)

music-notes11music-notes2music-notes11music-notes3

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

 

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 (Garden at Giverny, 1900 Claude Monet)                     least we’ll be able to attend a cooking class at Henry Ford West Bloomfield Hospital.

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.

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?

mhand_still-pondering-infinity_sm

(‘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’

music-notes31paintpalette1writingmusic-notes1

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.