'Purpose-built' Art in Hospitals

Art with Intent

Judy Rollins

• Publisher: Emerald Publishing Limited
• Year: 2021
• ISBN:
  9781839096822
• Topic: Médecine
• Subtopic: Santé publique, administration et soins

Over the past three decades, guidance on the selection of art in hospitals has suggested realistic art that depicts soothing and comforting images such as tranquil waters, green vegetation, flowers, and open spaces. Based on these findings, curators have been cautioned to avoid art with uncertain meaning that risks upsetting viewers in stressful states. However, some hospitals exhibit ambiguous or abstract art and cite anecdotal evidence of its appropriateness for healthcare settings. More recent research is going beyond anecdotal evidence, and indicates that the ambiguity of meaning in abstract compositions can have positive effects.

'Purpose-built' Art in Hospitals is built on an international study of artwork in hospitals around the globe. Exploring 'purpose-built' (specially commissioned) artwork in hospitals through the dual lens of an artist and healthcare professional, Rollins identifies 15 specific 'purposes' of visual artwork in hospitals and presents a compelling case for their use that is grounded in research. The book builds the reader's understanding of the many functions of artwork in hospitals, with the goal of encouraging greater variety in art offerings to better serve the many diverse needs of patients, families, visitors and staff within the hospital environment.

Chapter 1

The Hospital Experience

Hospitals have been referred to as the bookends of our lives; they may be the first physical environment we encounter and the last (Devlin & Andrade, 2017). Sandwiched between are occasions of our interactions as patients, family members, visitors, or staff. Other than the possible exception of childbirth, most occasions are unwelcomed and often associated with negative and depressing thoughts (Vavili & Kyrkou, 2014).

Upon admission, patients face the psychological demands relating to health care providers, administrative staff, other patients and their families, dietary staff, and the many other individuals who keep the hospital running. Nearly a half century ago, research at a children’s hospital estimated that patients encounter about 52 strangers during their first 24 hours of hospitalization (B. Johnson, 1975), and more than 70 in the event of major surgery (Gabriel & Danilowicz, 1980). It would be interesting to see if those numbers are more, less, or remain about the same today.

Hospital visits can activate high levels of stress for patients due to an unfamiliar setting, the insecurity of the future, the fear of unknown medical tests or surgery, the pain, and the restriction of social and everyday life (Vavili, 2009), all of which are psychologically demanding. Patients might experience changes in perception, attention, memory processes, and decision making, as well as feelings of distress, anxiety, fear, and depression (Devlin & Andrade, 2017). It is widely known that stress can inhibit healing; stress-related changes may create susceptibility to disease, affect disease progression, or retard the speed of recovery (Dougall & Baum, 2001; Ebrecht et al., 2004).

Although hospitalization is a stressful experience for anyone, research confirms that it is especially difficult for the developing child (Rollins & Mahan, 2010). Hospitalized children are rarely permitted to refuse treatments, medications, and procedures, and “things” are constantly being done to them. Teams of strangers ask them to hold still for painful procedures that they may not understand, leaving them feeling powerless and confused; younger children may wonder why their parents are letting these terrible things happen to them. Placed in passive roles with limited opportunities to make meaningful choices, children’s emotions are often intense. The hospital seethes with the unfamiliar. Sights, perhaps a strange cord or a wire on the wall, may look like a snake or monster at night. Children are exposed to many other strange sights, sounds, smells, and tastes – any of which can be scary if you don’t know what they are. Hearing another child crying can be frightening for other children as they wonder why the child is crying, what the child did to cause it to happen, and most importantly, “Are they going to do the same thing to me” (Rollins, 2016, p. 171). Separation from parents is difficult, especially for younger children, and for teenagers especially, separation from their friends. The stress of hospitalization often causes children to regress (e.g., a toilet trained toddler has accidents and a school-aged child returns to thumb sucking for comfort). It might take a month or more after discharge for children to return to their pre-hospitalization level of development. Regardless of all the negative issues, with appropriate support (including participation in creating art), hospitalization offers many opportunities for children to learn and grow from the experience (Vavili & Kyrkou, 2014).

Hospitalization also can be especially difficult for older adults. Research suggests a possible cognitive decline of more than double after a hospital stay, which affects patients’ thinking and memory skills (R. Wilson et al., 2012). The longer the person is hospitalized the greater the effect. A possible cause is delirium, which happens with about 20% of hospital patients. Described as a sudden change in mental function, delirium causes confusion, disorientation, and agitation, which might linger after discharge. Other causes include small, undetectable strokes or simply the boredom that comes from a lack of stimulation. A physical decline might also occur. Patients are typically in their hospital bed much of the day and become weaker and less able to return to their pre-admission status. Covinsky, Pierluissi, and Johnston (2011) found that nearly a third of patients over 70 years of age and over half of patients over 85 leave the hospital with a greater level of disability than when they arrived.

Family members, too, are susceptible to the stresses inherent in the hospital experience. Hospitalization of a family member can represent a time of great vulnerability as family members in a heightened emotional state tend to give priority to the welfare of their ill relative, thereby often adversely putting their own health at risk. Family members may experience anxiety and depression when faced with fear of their loved one’s death, uncertainties related to the prognosis and treatment, emotional conflicts, concerns about financial conditions, changes of roles, and disruption of routine and family bonds (Rückholdt, Tofler, & Buckley, 2017). Everyday life screeches to a halt, yet matters outside the hospital, such as employment or childcare, still must be tended to. Family members who adopt the role of informal caregiver for their relative are reported to be at an increased risk for anxiety, depression, and post-traumatic stress symptoms (Haines, Denehy, Skinner, Warrillow, & Berney, 2015).

The hospital environment has a profound impact on staff as well. Hospitals are ranked among the most stressful work environments, especially for nurses, the primary providers of hospital patient care. Often, supportive policies that encourage nurses to take a break from the hectic pace are nonexistent or unsupported, and stress-reducing restorative break rooms are unavailable or are in locations too distant from patients for nurses to feel comfortable leaving them (Nejati, Shepley, Rodiek, Lee, & Varni, 2015). Fatigue and burnout among nursing staff can lead to lack of focus and concentration, which can result in serious negative consequences for both staff members and patients. There are economic consequences for the hospital as well; the average cost of turnover for a bedside registered nurse is $52,100 and ranges from $40,300 to $64,000 (NSI Nursing Solutions, Inc., 2019).

Physicians, nurses, and other medical professionals in hospitals are at an especially high risk of burnout – a state of physical, emotional, or mental exhaustion combined with doubts about their competence and the value of their work (Swanson, 2018). In fact, rates of burnout are high, with 70% of nurses reporting burnout in their current positions (Zimmerman, 2017), and more than half of physicians reporting at least one symptom of burnout (Shanafelt et al., 2015). Even without complete burnout, hospital employees routinely experience stress and anxiety, which can affect both their work and personal lives.

Although some stressors that patients face, such as illness and treatment, are unavoidable, others are not. The precarious nature of caring for sick humans will always be a factor in a hospital environment. Both physical and psychosocial environmental factors are in play as sources of stress. A review of some of these factors is offered here and will be explored in greater detail in the chapters that follow.

The Impact of the Physical Environment

Numerous studies have shown that the physical environment of hospitals can affect health and comfort of its occupants, that is, patients, families, visitors, and staff. Eijkelenboom and Bluyssen’s (2019) literature review of 79 studies revealed that health and comfort of staff as well as of patients from different hospital departments vary. The extent to which environmental stimuli, such as noise, can cause stress depends on the importance of the stressor, duration of exposure, and degree of control (Folkman, 2013). Age of the patient is also a consideration; Prescott and David (1976) reported that children, who live according to the information provided by their senses, remember places and sensations more than they remember people. Thus, they are likely more sensitive to their surroundings than are adults and may be affected deeply and for a long time by details of which adults are unaware.

Hospitals are noisy places. Call bells, alarms, visitors, staff conversations, mobile phones, overhead paging systems, rumbling carts and equipment, hospital ventilation systems that run at powerful settings, and unlimited family visiting hours – all contribute to the soundscape of the hospital environment. Some design features, such as open nurses stations or easy to clean hardwood or tile floors good for infection control, also have noise implications. According to Florence Nightingale (1860), “Unnecessary noise is the most cruel absence of care that can be inflicted on the sick or the well” (p. 44). Studies have indicated that noise can be detrimental to both patient and staff well-being (Blienfnick, Ryherd, & Jackson, 2019). Regarding patients, for example, noise has been associated with extended hospital stay, increased incidence of re-hospitalization, increased dosages of pain medication, feelings of fear of helplessness, and, perhaps one we hear about most often, sleep disturbance. For staff, noise can hinder oral communication, which can result in errors in task performance, and job satisfaction, which may lead to burnout. Continuous exposure to high levels of noise can potentially lead to hearing loss.

Despite the World Health Organization’s 1995 guidelines of recommended hospital noise levels, a landmark survey of hospital noise research conducted in 2005 disclosed that hospital daytime noise had risen 200% and nighttime noise 400% since 1960 (Busch-Vishniac et al., 2005). Although noise intervention procedures, such as innovative new materials, evidence-based facility design, and thoughtful hospital policies have led to progress in reducing hospital noise levels, quietness of the hospital environment remains one of the two worst rated categories in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys patients in US hospitals complete after discharge (HCAHPS, 2019). Research findings have suggested potential relationships between hospital noise and patient satisfaction (Blienfnick et al., 2019).

As mentioned, one of the most commonly reported effects of noise in hospitals is sleep disturbance. Other environment factors, such as light, air quality, room temperature, room layout, and nursing care activities that can wake patients during the night can affect patient sleep (DuBose & Hadi, 2016). Poor sleep is associated with negative health outcomes for everyone, and the consequences are especially problematic for hospital patients. Serious impacts of sleep deprivation include decreased pain tolerance, increased immunosuppression, delayed healing, confusion, disorientation and delusions, higher blood pressure, and higher heart rate; longer term impacts include decreased performance on activities of daily living, lower physical functioning after release from the hospital, higher overall mortality 1-year post discharge, and incidence of delirium (Hadi, DuBose, & Choi, 2019).

As often the first point of contact for individuals entering the hospital, waiting areas deserve special consideration. These areas are associated with boredom or anxiety or both, even if the visit is routine. But perhaps most significant, waiting areas can represent the shift from the personal identity as “individual” to “patient,” which then is further aggravated by the suspension of active engagement and loss of control over the sense of time and freedom to move about (Biddiss, McPherson, Shea, & McKeever, 2013). The environment of waiting areas not only has an impact on patients but also on those family members and friends who accompany them. Consider, for example, the stress family members experience while awaiting updates on their loved one undergoing surgery or other procedures. It is little wonder that waiting areas are often considered the most stressful locations in hospitals.

For children, a waiting area can mean exposure to unfamiliar people, separation anxiety, restricted movement, and anticipation of painful or uncomfortable procedures. Fear may be even greater for children with chronic diseases or disabilities when they anticipate invasive or painful procedures, have misconceptions of their illness, and face uncertainty about their futures (C. Ward, Brinkman, Slifer, & Paranjape, 2010).

Psychosocial Issues

Hospital buildings are sophisticated public areas. Although the buildings generally cover all the functional requirements, often they are not able to face the psychological needs of patients, family members, visitors, and staff (Garip, 2011). Much research has been conducted concerning how the hospital’s physical environment affects emotions and behavior.

Environmental psychologists are concerned with the transactions between individuals and their physical settings (Gifford, 2014). Various theories relevant to hospitals have been developed within environmental psychology. The press-competence theory is the one commonly used to explain individuals’ responses to the hospital’s physical environment. According to Lawton and Nahemow (1973), the more compromised patients are with regard to their physical or emotional health, the more susceptible they might be to negative aspects of the physical environment. When the competence level of an individual is high, environments with a high level of press (very challenging) are appropriate; when competence is low, an overtaxing environment can be overwhelming. If the individual’s competence level is appropriate for the level of environmental press, adaptive behavior is most successful. When the environment is inappropriately matched with the individual’s level of competence, difficulty can occur. Shepley (2018) explains, “Hospitals, for example, which may be confusing or technologically overstimulating, can undermine a patient’s self-confidence” (p. 313).

Below, five psychosocial issues related to the physical environment of hospitals are explored: (1) control, (2) privacy and social interaction, (3) personal space, (4) territoriality, and (5) comfort and safety (Shepley, 2018). The reader will see that all of these terms are interrelated. Although discussed with the patient in mind, many of the concepts apply to family members as well.

Control

Individuals can have feelings of disempowerment or lack of control when their health is compromised. The confusing hospital environment might offer them little control over their surroundings, which can cause extreme emotional responses, including insecurity, anxiety, and challenges with self-esteem and assessments of competence (Passini, 2002).

Providing increased possibilities for control in an environment where there may be few can improve individuals’ mental health (Evans, 2003). Employing principles of environmental psychology has led to improved hospital design with features that provide more control for patients (e.g., control of room temperature and control of room lighting from the hospital bed). Staff can offer patients choices whenever possible, such as timing of procedures and even simple decisions such as choice of arm for a blood draw or blood pressure reading or food choices among those allowed. For children, even something as simple as choosing a particular band aid or sticker after undergoing a procedure can be a very significant event as children have even fewer opportunities than adults to make choices in the hospital, including the decision to leave the facility should they choose to do so. Offering patients a choice of artwork to exhibit in their room is another important way to address the issue of lack of control.

Specific care models can be used to help patients and families capture control. Increasingly, health care providers are implementing patient-centered care, which promotes the patient’s voice in all issues of care. Patient-centered care is care that is respectful of, and responsive to, individual patient preferences, needs, and values, and ensures that patient values guide all clinical decisions...

Table of contents

• Cover
• Title
• Introduction
• Chapter 1. The Hospital Experience
• Chapter 2. Art for Soothing and Comforting
• Chapter 3. Art for Transcendence
• Chapter 4. Art for Empathy
• Chapter 5. Art for Inspiration and Hope
• Chapter 6. Art for Spirituality
• Chapter 7. Art for Joy
• Chapter 8. Art for Interaction
• Chapter 9. Art for Identity
• Chapter 10. Art for Messaging
• Chapter 11. Art for Wayfinding
• Chapter 12. Art to Build Community
• Chapter 13. Art to Build Relationships
• Chapter 14. Art for Dialogue
• Chapter 15. Art for Remembrance
• Chapter 16. Art for Museum Encounters
• Chapter 17. Transforming the Hospital Experience through Art
• Chapter 18. Conclusions and Looking Forward
• References
• Index